Eight principles for safer opioid prescribing and cautions with benzodiazepines |
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Authors: | Lynn R Webster Gary M Reisfield Nabarun Dasgupta |
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Institution: | 1. PRA Health Sciences, Salt Lake City, UTLRWebsterMD@gmail.com;3. Pain Management Services, Division of Addiction Medicine, Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL;4. Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA |
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Abstract: | The provision of long-term opioid analgesic therapy for chronic pain requires a careful risk/benefit analysis followed by clinical safety measures to identify and reduce misuse, abuse, and addiction and their associated morbidity and mortality. Multiple data sources show that benzodiazepines, prescribed for comorbid insomnia, anxiety, and mood disorders, heighten the risk of respiratory depression and other adverse outcomes when combined with opioid therapy. Evidence is presented for hazards associated with coadministration of opioids and benzodiazepines and the need for caution when initiating opioid therapy for chronic pain. Clinical recommendations follow, as drawn from 2 previously published literature reviews, one of which proffers 8 principles for safer opioid prescribing; the other review presents risks associated with benzodiazepines, suggests alternatives for co-prescribing benzodiazepines and opioids, and outlines recommendations regarding co-prescribing if alternative therapies are ineffective. |
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Keywords: | opioid analgesics benzodiazepines chronic pain mortality drug overdose therapeutic use |
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