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Comment & Response
October 23/30, 2013

Risks Associated With Opioid Use

Author Affiliations
  • 1Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, New York
JAMA. 2013;310(16):1738. doi:10.1001/jama.2013.277291

To the Editor Increasing opioid use for pain has been associated with adverse consequences, including prescription drug abuse and addiction. Yet opioids are essential drugs for pain associated with life-limiting illnesses and for selected patients with other chronic pain syndromes. A balanced approach to these drugs is needed that minimizes risk through cautious patient selection and safer prescribing, without denying care to those who might benefit.

I believe that Dr Dowell and colleagues1 did not promote a balanced approach in their Viewpoint. They suggested that the risk of addiction arises primarily from the drug and is so difficult to manage that clinical assessment is inadequate to estimate risk vs benefit. The conclusion that follows is that prolonged opioid use may only be appropriate in end-of-life care. I disagree with their argument.