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The JAMA Network Collection of Articles About Opioids

Opioid use and addiction have increased in parallel to one another with the incidence of both rising exponentially. Currently, more than 200 million prescriptions are written per year for opioids in the United States and 2 million Americans fulfill the criteria for substance use disorder. Given these numbers, all clinicians will provide care for patients using these medications or experiencing their complications, most especially addiction. To assist clinicians in managing opioid-related problems, we have assembled a collection of articles published in the JAMA Network on opioids. We have also produced new audio content and CME activities to facilitate learning about opioids to help clinicians be better prepared for providing care to patients using or misusing opioid medications.

This site features the CDC guideline as well as related resources from the JAMA Network. It contains additional material clinicians will need to act on the recommendations in the guidelines. A section on opioid addiction treatment is included and sections on proper opioid prescribing practices and how to treat pain without opioids are forthcoming

The CDC Guideline for Prescribing Opioids for Chronic Pain

In response to increasing use of opioid medications and worsening trends in opioid addiction rates, the Centers for Disease Control and Prevention (CDC) published a new guideline in the April 19, 2016 issue of JAMA. The guideline has recommendations for primary care clinicians regarding the proper use of opioids for managing chronic pain exclusive of active cancer treatment and palliative or end-of-life care. The guideline covers:

  1. Determining when to initiate or continue opioids for chronic pain
  2. Opioid selection, dosage, duration, follow-up, and discontinuation
  3. Assessing risk and addressing harms of opioid use

CDC Guideline

CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 CME

Deborah Dowell and Coauthors

JAMA | Special Communication, April 19, 2016

Opioid Prescribing for Chronic Pain: Not for the Faint of Heart

Mitchell H. Katz

JAMA Internal Medicine | Editorial, May 2016

The CDC Guideline on Opioid Prescribing: Rising to the Challenge

Yngvild Olsen

JAMA | Editorial, April 19, 2016

Zero Pain Is Not the Goal

Thomas H. Lee

JAMA | Editorial, April 19, 2016

Opioid Prescribing After Surgical Extraction of Teeth in Medicaid Patients, 2000-2010

James A. Baker and Coauthors

JAMA | Research Letter, April 19, 2016

Opioids Prescribed After Low-Risk Surgical Procedures in the United States, 2004-2012

Hannah Wunsch and Coauthors

JAMA | Research Letter, April 19, 2016

Opioids for Chronic Pain

LeShaundra Cordier Scott and Sarah Lewis

JAMA | JAMA Patient Page, April 19, 2016

Related Multimedia

Issues in opioid prescribing – a conversation about the CDC opioid guideline

Treatment of Opioid Addiction

Considerable controversy exists regarding the appropriate way to treat opioid addiction. Treatments range from life-long opioid replacement therapy to complete withdrawal. This collection of articles and podcasts reviews all the treatment options and the barriers that exist to providing care for patients with opioid-related substance use disorder.

In the July 19, 2016, issue of JAMA a randomized clinical trial demonstrating the efficacy of an implantable buprenorphine-releasing device was published showing that this is an effective means for treating opioid use disorder. An accompanying podcast with the study author, Dr Richard Rosenthal, reviews use of this device and a general discussion about the treatment of opioid addiction. A JAMA Clinical Guideline Synopsis was also published summarizing the Vancouver opioid use disorder guideline. This guideline is a very useful resource for clinicians who treat patients who have opioid use disorder. The guideline can be found at http://www.vch.ca/media/Opioid-Addiction-Guideline.pdf.

The Vancouver Opioid Addiction Treatment Guideline:
A comprehensive resource for primary care clinicians treating opioid addiction in an office-based practice

Treatment of opioid addiction in the medical office:
Overview of the regulatory requirements for physicians provided office-based opioid addiction treatment in the U.S.

Treatment of Addiction

Buprenorphine Implants (Probuphine) for Opioid Dependence

From The Medical Letter on Drugs and Therapeutics

JAMA | November 1, 2016

Risks of Developing Persistent Opioid Use After Major Surgery

Neilesh Soneji and Coauthors

JAMA Surgery | Research Letter, November 2016

Clinical Management of Opioid Use Disorder

Beth Dunlap and Adam S. Cifu

JAMA | JAMA Clinical Guidelines Synopsis, July 19, 2016

Hydromorphone Compared With Diacetylmorphine for Long-term Opioid Dependence: A Randomized Clinical Trial CME

Eugenia Oviedo-Joekes and Coauthors

JAMA Psychiatry | Original Investigation, May 2016

Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence: A Randomized Clinical Trial CME

Gail D’Onofrio and Coauthors

JAMA | Original Investigation, April 28, 2015

Buprenorphine Treatment for Hospitalized, Opioid-Dependent Patients: A Randomized Clinical Trial CME

Jane M. Liebschutz and Coauthors

JAMA Internal Medicine | Original Investigation, August 2014

The Changing Face of Heroin Use in the United States: A Retrospective Analysis of the Past 50 Years CME

Theodore J. Cicero and Coauthors

JAMA Psychiatry | Original Investigation, July 2014

Abuse-Deterrent Formulations and the Prescription Opioid Abuse Epidemic in the United States: Lessons Learned From OxyContin

Theodore J. Cicero and Matthew S. Ellis

JAMA Psychiatry | Original Investigation, May 2015

Association of Opioid Agonist Therapy With Lower Incidence of Hepatitis C Virus Infection in Young Adult Injection Drug Users

Judith I. Tsui and Coauthors

JAMA Internal Medicine | Original Investigation, December 2014

Primary Care–Based Buprenorphine Taper vs Maintenance Therapy for Prescription Opioid Dependence: A Randomized Clinical Trial

David A. Fiellin and Coauthors

JAMA Internal Medicine | Original Investigation, December 2014

A Randomized, Double-blind Evaluation of Buprenorphine Taper Duration in Primary Prescription Opioid Abusers

Stacey C. Sigmon and Coauthors

JAMA Psychiatry | Original Investigation, December 2013

Chronic Care Management for Dependence on Alcohol and Other Drugs: The AHEAD Randomized Trial

Richard Saitz and Coauthors

JAMA | Original Investigation, September 18, 2013

Collaborative Care of Opioid-Addicted Patients in Primary Care Using Buprenorphine: Five-Year Experience

Daniel P. Alford and Coauthors

JAMA Internal Medicine | Original Investigation, March 14, 2011

Buprenorphine Implants for Treatment of Opioid Dependence: A Randomized Controlled Trial

Walter Ling and Coauthors

JAMA | Original Contribution, October 13, 2010

The Untapped Potential of Office-Based Buprenorphine Treatment

Stacey C. Sigmon

JAMA Psychiatry | Research Letter, April 2015

The CDC Guideline on Opioid Prescribing: Rising to the Challenge

Yngvild Olsen

JAMA | Editorial, April 19, 2016

Community Approaches to the Opioid Crisis

Howard Koh

JAMA | The JAMA Forum, October 13, 2015

Mandatory Use of Prescription Drug Monitoring Programs

Rebecca L. Haffajee and Coauthors

JAMA | Viewpoint, March 3, 2015

Treating Prescription Opioid Dependence

Charles Ruetsch

JAMA | From the JAMA Network, September 17, 2014

Improving Care for Hospitalized, Opioid-Dependent Patients: A Promising Start

Margot Kushel

JAMA Internal Medicine | Invited Commentary, August 2014

Access to Treatment for Opioid Dependence in Rural America: Challenges and Future Directions

Author and Coauthors

JAMA Psychiatry | Viewpoint, April 2014

Opioid Dependence vs Addiction: A Distinction Without a Difference?

Jane C. Ballantyne and Coauthors

JAMA Internal Medicine | Commentary, Sep 24, 2012

Related Multimedia

Comprehensive review of opioid addiction treatment including interviews with Drs. Evan Wood and Keith Ahamad who helped develop the Vancouver opioid addiction treatment guideline and Dr. Tony Yaksh, Professor of Pharmacology at UCSD.

Dr Richard Rosenthal discusses treating opioid use disorder using implantable devices

opioid treatment image cropped opioid treatment image

Using Opioids

Pain is one of the most common reasons patients seek medical care. In recent years, there has been increasing use of opioids to treat pain resulting in problems relating to opioid addiction. Opioids should be used cautiously. The following is a series of article published in the JAMA Network regarding pain management using opioids.

Using Opioids

Inappropriate Opioid Dosing and Prescribing for Children: An Unintended Consequence of the Clinical Pain Score?

Terri Voepel-Lewis and Coauthors

JAMA Pediatrics | Viewpoint, November 14, 2016

2016 Update on Medical Overuse: A Systematic Review

Daniel J. Morgan and Coauthors

JAMA Internal Medicine | Review, November 2016

Rates of Neonatal Abstinence Syndrome Amid Efforts to Combat the Opioid Abuse Epidemic

Joshua D. Brown and Coauthors

JAMA Pediatrics | Research Letter, November 2016

Choice of Analgesics After Adenotonsillectomy: Are We Between a Rock and a Hard Place?

Jayant M. Pinto and Coauthors

JAMA Otolaryngology—Head & Neck Surgery | Viewpoint, November 2016

Association Between Nonmedical Use of Prescription Drugs and Suicidal Behavior Among Adolescents

Lan Guo and Coauthors

JAMA Pediatrics | Original Investigation, October 2016

Use of Opioid Agonist Therapy for Medicare Patients in 2013

Anna Lembke and Jonathan H. Chen

JAMA Psychiatry | Research Letter, September 2016

Incidence of and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients in the Postoperative Period

Eric C. Sun and Coauthors

JAMA Internal Medicine | Original Investigation, September 2016

Access to Prescription Opioids—Primum Non Nocere: A Teachable Moment

Patrick D. Tyler and Coauthors

JAMA Internal Medicine | Teachable Moment, September 2016

Incidence of and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients in the Postoperative Period

Eric C. Sun and Coauthors

JAMA Internal Medicine | Original Investigation, September 2016

Hospital Prescribing of Opioids to Medicare Beneficiaries

Anupam B. Jena and Coauthors

JAMA Internal Medicine | Original Investigation, July 2016

Opioid Prescribing After Surgical Extraction of Teeth in Medicaid Patients, 2000-2010

James A. Baker and Coauthors

JAMA | Research Letter, April 19, 2016

Distribution of Opioids by Different Types of Medicare Prescribers

Jonathan H. Chen and Coauthors

JAMA Internal Medicine | Research Letter, February 2016

Effect of Florida’s Prescription Drug Monitoring Program and Pill Mill Laws on Opioid Prescribing and Use

Lainie Rutkow and Coauthors

JAMA Internal Medicine | Original Investigation, October 2015

Association Between Regulatory Advisories and Codeine Prescribing to Postpartum Women

Kate Smolina and Coauthors

JAMA | Research Letter, May 12, 2015

Prescription Opioid Duration of Action and the Risk of Unintentional Overdose Among Patients Receiving Opioid Therapy

Matthew Miller and Coauthors

JAMA Internal Medicine | Original Investigation, April 2015

Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010

Marcus A. Bachhuber and Coauthors

JAMA Internal Medicine | Original Investigation, October 2014

High-Risk Use by Patients Prescribed Opioids for Pain and Its Role in Overdose Deaths

Jane A. Gwira Baumblatt and Coauthors

JAMA | Original Investigation, May 2014

Chronic Back Pain With Possible Prescription Opioid Misuse CME

Daniel P. Alford

JAMA | Clinical Crossroads, Conferences With Patients and Doctors, March 6, 2013

Improving Opioid Prescribing: The New York City Recommendations

David N. Juurlink and Coauthors

JAMA | Viewpoint, March 6, 2013

Methadone Overdose Deaths Rise With Increased Prescribing for Pain

Bridget M. Kuehn

JAMA | Medical News and Perspectives, August 22/29, 2012

Patient Satisfaction, Prescription Drug Abuse, and Potential Unintended Consequences

Aleksandra Zgierska and Coauthors

JAMA | Viewpoint, April 4, 2012

Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths

Amy S. B. Bohnert and Coauthors

JAMA | Original Contribution, April 6, 2011

Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments

Mark J. Pletcher and Coauthors

JAMA | Original Contribution, January 2, 2008

Management of Intractable Nausea and Vomiting in Patients at the End of Life: "I Was Feeling Nauseous All of the Time . . . Nothing Was Working" CME

Gordon J. Wood and Coauthors

JAMA | Perspectives on Care at the Close of Life, September 12, 2007