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      Opioids for chronic noncancer pain: a position paper of the American Academy of Neurology.

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      Neurology

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          Abstract

          The Patient Safety Subcommittee requested a review of the science and policy issues regarding the rapidly emerging public health epidemic of prescription opioid-related morbidity and mortality in the United States. Over 100,000 persons have died, directly or indirectly, from prescribed opioids in the United States since policies changed in the late 1990s. In the highest-risk group (age 35-54 years), these deaths have exceeded mortality from both firearms and motor vehicle accidents. Whereas there is evidence for significant short-term pain relief, there is no substantial evidence for maintenance of pain relief or improved function over long periods of time without incurring serious risk of overdose, dependence, or addiction. The objectives of the article are to review the following: (1) the key initiating causes of the epidemic; (2) the evidence for safety and effectiveness of opioids for chronic pain; (3) federal and state policy responses; and (4) recommendations for neurologists in practice to increase use of best practices/universal precautions most likely to improve effective and safe use of opioids and to reduce the likelihood of severe adverse and overdose events.

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          Author and article information

          Journal
          Neurology
          Neurology
          1526-632X
          0028-3878
          Sep 30 2014
          : 83
          : 14
          Affiliations
          [1 ] From the Departments of Occupational and Environmental Health Sciences, Neurology, and Health Services, University of Washington, Seattle. meddir@uw.edu.
          Article
          WNL.0000000000000839
          10.1212/WNL.0000000000000839
          25267983
          c80e703c-5ffa-4d04-9a9d-ffad10beb4a5
          © 2014 American Academy of Neurology.
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