Continuing evolution of opioid use in primary care practice: implications of emerging technologies.

Stanos, Steven

BACKGROUND Primary care physicians, nurse practitioners, and nurses are often the first to evaluate patients with pain and many patients depend on these clinicians for pain relief. The growing evidence supporting use of opioids for appropriately selected patients means that primary care practitioners must be knowledgeable regarding ever-evolving pain-management strategies. SCOPE This review summarizes core considerations in opioid prescribing in the primary care setting, the risks of undertreatment of pain, the challenges and barriers associated with prescribing opioids, identifying risk factors that may predict problematic use, and emerging formulation technologies expected to assist clinicians in better achieving effective pain control while minimizing risks for misuse or diversion. RESULTS Primary care physicians face considerable challenges in optimizing pain management while minimizing potential for misuse, abuse and diversion. Opioid treatment decisions are based not only on the type of pain but also the patient's psychosocial history, including a screening for predicting aberrant behaviors and, in some patients, substance abuse. New opioid formulations are available to assist clinicians in achieving adequate patient relief while reducing risk of tampering and abuse. Primary care practitioners need to be aware of these new options and integrate them into clinical treatment decisions. CONCLUSIONS The strategic use of new opioid formulations and better patient assessment may lead to more successful use of opioids in the management of pain, while limiting or lowering the risk of the development of an addiction problem, abuse or diversion.