Dr Katz1 persuasively articulates what many physicians are now thinking as they witness the casualties of chronic noncancer pain (CNCP) opioid therapy first hand and also comments on well-designed studies of adverse consequences now regularly appearing in the pain, pharmacology, and internal medicine literature.
Believers in opioid therapy for CNCP were influenced by a noble impulse to right a series of wrongs. Following decades of opioid excesses, the federal government seized control of opioid prescribing between 1915 and 1920 and severe opiophobia ensued, leading to the neglect of patients, the criminalization of addiction, and the prosecution of physicians. Even as the undertreatment of pain still persists for many populations throughout the world, the pendulum is now swinging back to fears of opioid's hazards in CNCP, particularly when a morphine equivalent dose exceeds a threshold of 100 to 200 mg.
Kornfeld H. Buprenorphine as a Safety Net for Opioid Treatment of Nonmalignant Pain. Arch Intern Med. 2011;171(6):596–597. doi:10.1001/archinternmed.2011.83
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