What Every Prescriber and Pharmacist Needs to Know About Addiction National Rx Drug Abuse Summit 4-10-12

14. Prevalence of Recurrent
and Persistent Pain in the US
• 1 in 4 Americans suffer from recurrent pain (day-long bout
of pain/month)
• 1 in 10 Americans report having persistent pain of at least
one year s duration
• 1 in 5 individuals over the age of 65 report pain persisting
for more than 24 hours in the preceding month
– 6 in 10 report pain persisting > 1 year
• 2 out of 3 US armed forces veterans report having
persistent pain attributable to military service
– 1 in 10 take prescription medicine to manage pain
American Pain Foundation. http://www.painfoundation.org. Accessed March 2010.

15. National Institutes of Health. New Directions in Pain Research.
Sept 1998. PA-98-102.

17. DAWN 2009
 Heroin 213,118 visits
 Narcotic Pain Relievers: 397,160 visits
 Oxycodone/combinations – 175,949 visits
 Hydrocodone/combinations – 104,490 visits
 Fentanyl/combinations – 22,143 visits
 Buprenorphine/combinations – *12,544 *estimate may be
low because
buprenorphine is not
 Alcohol involvement: 32% of visits
specifically queried
Source: Drug Abuse Warning Network, National Estimate, 2010; The Drug Abuse Warning Network
(DAWN) is a public health surveillance system that monitors drug-related morbidity and
mortality. DAWN uses a probability sample of hospitals to produce estimates of drug-related
emergency department (ED) visits for the United States and selected metropolitan areas
annually. DAWN also produces annual profiles of drug-related deaths reviewed by medical
examiners or coroners in
selected metropolitan areas and States.

20. The majority of unintentional overdose deaths were related to opioid use including
oxycodone, hydrocodone, and methadone, often in combination with other drugs
and/or alcohol.
Source: Methadone Mortality Conference, CSAT/SAMHSA, July 2010
http://www.cdc.gov/HomeandRecreationalSafety/pdf/poision-issue-brief.pdf

22. A Common Dilemma in Medicine

23. NSAIDS
Lithium O
Antidepressants Opioids
Stimulants Anticonvulsants Acetominophen
Antipsychotics Alpha blockers Steroids
Beta-blockers BZDs

24. A-delta (myelinated) and C (unmyelinated) afferents
Anatomy of Pain with cell bodies in dorsal root ganglion act as
nociceptors: sensitive to noxious stimuli: heat,
mechanical, irritating chemicals
Sensitization in local tissue with release of
prostaglandins, bradykinins, leukotrienes
Nociceptors can cause release of Substance P resulting
in further local inflammation
Axons of primary afferent nociceptors enter spinal cord
via the dorsal root terminating in dorsal horn of spinal
gray matter
Spinal neurons then transmit pain signals to brain:
thalamus which projects to somatosensory cortex
(ascending transmission)
Projections to cortical regions (cingulate and frontal
lobe) linked to emotional responses resulting in
unpleasant emotional perceptions
Pain can be modulated via a descending circuit that has
links in hypothalamus, medulla, and midbrain.
Selectively controls spinal pain transmission neurons;
contains endogenous opioids

29. Diet/
Trigger
Point
Exercise/PT
Anticonvulsant
Injections
s
Surgery
Nerve
Block
Pain
Chiropractic
Treatment
Massage/Yoga
Cognitive
Acupuncture
Behavioral
Therapy
TENS

33. Opioid
Risk
Tool
(ORT)
• Administration
• On
initial
visit
• Prior
to
opioid
therapy
• Scoring
• 0-­‐3:
low
risk
(6%)
• 4-­‐7:
moderate
risk
(28%)
• >
8:
high
risk
(>
90%)
Webster & Webster. Pain Med. 2005;6:432.

36. Opioids
for
Pain
Management

48. Passik SD, Kirsh KL. J Supportive Oncology, 2005.

50. Clinical Support Systems
Sponsored by Center for Substance Abuse Treatment/SAMHSA

56. References