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Sunday, February 23, 2020

ASRA encourages best practices in opioid prescription, society president says ahead of meeting in New Orleans

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By Karen Kidd | Nov 12, 2019

Participants in a previous American Society of Regional Anesthesia and Pain Medicine meeting | Photo courtesy of the American Society of Regional Anesthesia

At at time when opioid manufacturers and distributors face massive litigation across the country, the head of a professional society holding its annual meeting in New Orleans later this week said during a recent interview that patients should still have access to the potent pain killers - as a "rescue" drug.

American Society of Regional Anesthesia and Pain Medicine (ASRA) president Eugene R. Viscusi told the Louisiana Record that leading up to the crisis, prescriptions were written based on two false premises. 

"One is that any pain can be treated with an opioid if you just give enough," Viscusi said. "The other is that opioids are the single most potent analgesic available."

Both concepts are incorrect but are the reason opioids have been inappropriately prescribed, "often in absurdly high doses," he said.

"There is still a place for opioids, but they are best used in the context of a rescue drug - on top of and when non-opioid agents and interventional techniques are insufficient," he said. "We must also temper patient expectations by explaining that 'no pain' is often not a reasonable goal, but, rather, that the goal be reduced pain that permits normal activities and quality of life."

Placing opioids in the context of a rescue treatment or as a last-resort option when other approaches fail, means they are more likely to be prescribed only when there is a clear benefit to the patient, Viscusi said.

"So, pain management should never be opioids first or primarily opioids but, rather, when non-opioids have failed or are contraindicated," he said. "Opioids should only be continued when a trial clearly demonstrates benefit and never escalated unless a clear benefit is obtained."

Opioid use is being litigated in thousands of cases across the nation and most local governments in Louisiana have become involved in opioid litigation, with 17 law firms handling most of that litigation in the state. In July, Louisiana Attorney General Jeff Landry added the state to opioid multidistrict litigation before a federal judge in Ohio.

Litigation further complicates an already complicated healthcare issue that professionals must address on a patient-by-patient basis.

"Pain is a very complicated experience to treat because of its multifactorial nature," Viscusi said. "Pain and treatment responses differ tremendously from one person to another."

The 18th annual ASRA meeting is scheduled Thursday through Saturday at the New Orleans Marriott on Canal Street. More than 1,400 physicians, residents, pain fellows, physician assistants, nurse practitioners, nurses and other healthcare professionals are expected to attend the scientific and educational event.  National and international experts are expected to lead sessions on topics that include radiofrequency ablation and how to treat patients with challenging conditions such as fibromyalgia, chronic fatigue syndrome, and headache.

Naturally, the use of opioids as part of a paint treatment plan will come up during the meeting but the ASRA encourages a moderate approach to opioid use, Viscusi said.

"ASRA has a long history of promoting opioid-reducing techniques for both acute and chronic pain utilizing multimodal techniques, typically employing regional anesthesia and interventional pain techniques," he said. "In my introductory address, I will echo the message of our Surgeon General Jerome Adams at our recent spring meeting concerning the opioid crisis where he emphasized the need for all physicians in the pain space to better understand best practices in opioid prescribing as well as to initiate buprenorphine treatment in the setting of opioid use disorder (OUD)."  

Use of opioids, their alternatives and managing patients who are experiencing OUD are critical and evolving issues that face pain medicine physicians and healthcare providers in the field, Viscusi said.

"These topics are always interwoven into our program, with a focus on finding safe and effective alternatives and managing our patients and improving their care," he said. "It is critical that we continue to find and perfect options because of the huge toll that pain takes on our society and in pursuit of our ultimate goal – to help patients be able to lead productive, meaningful lives."

The 367 abstracts expected to be presented during the meeting include those examining research and case studies that test opioid prescriptions and alternatives to manage OUD. Sessions are expected to include "A Brave New World: Novel Opioid Targets" covering the science of opioid-biased ligands, endomorphin analogs, and low-dose naltrexone.

"Another session looks specifically at adolescents and vulnerability to opioid addiction issues, and one looks specifically at treating pain in children," Viscusi said. "We also have two sessions that deal with prescribing opioids to patients who use cannabis/marijuana products."

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