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Identifying and managing the risk of opioid misuse

Howard S Smith and Kenneth L Kirsh

Opioids have become an accepted, if sometimes debated, part of pain management. With increased use, there has been a rise in the abuse and diversion of opioids. Providers need to acknowledge this relationship and perform due diligence when assessing whether a patient with chronic pain is a good candidate for a trial of opioid therapy, and assess the amount of oversight and monitoring needed based upon potential risk factors. While it might be advantageous to consult a board-certified pain practitioner, the reality is that there are few such practitioners available, and the job of treating pain often falls to the primary care provider. To aid in the endeavor, several suggestions for practice are made to help primary care providers feel more comfortable treating pain patients.