Opioid Safety, Respiratory Compromise

Two Precautions for Treating Opioid Naive Patients

The National Comprehensive Cancer Network defines an opioid naive patient as one who “has not chronically receiving opioid analgesics on a daily basis.”

Recent research and opinion in patient safety suggest precautions for treating the opioid naive patient be taken:

Precaution #1 – Surgery may Predispose the Opioid Naive Patient to Chronic Opioid Use.

In a retrospective study by Eric C. Sun, MD, PhD (Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford) and his colleagues, “Incidence of and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients in the Postoperative Period,” the health claims of privately insured patients between January 1, 2001, and December 31, 2013 were analyzed.

The researchers concluded:

In opioid-naive patients, many surgical procedures are associated with an increased risk of chronic opioid use in the postoperative period. A certain subset of patients (eg, men, elderly patients) may be particularly vulnerable.

Precaution #2 – Management of Pain is More Than Just about Opioids.

While the media may have a fixation on opioid use and overdose since the death of Prince, Michael Leong, MD (Clinical Associate Professor, Stanford University Medical Center’s) reminds us that effective pain management is more than just about the prescribing and use of opioids:

For people in pain, opioids are just one leg of a chair. The other three legs — which are often missing from the debate on opioid addiction — can support equal weight if the right medical expertise and infrastructure are in place.

In citing recommendations from the American Society of Anesthesiologists, this “four-leg” approach – called multimodal – Dr. Leong recommends these three other legs be considered:

  • nonaddictive over-the-counter pain medications
  • neuromodulation
  • mind/body regimens

 

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