Characterizations of Long-term Oxycodone/Acetaminophen Prescriptions in Veteran Patients

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Abstract
The long-term use of opioids for the treatment of chronic pain of nonmalignant origin has been generally supported by specialists in pain management as a less than ideal but often necessary and humane course of treatment.1-4 The main theses presented are quite consistent, specifically that patients without cancer deserve maximum treatment for chronic pain, that fears of consequential clinical dependencies are generally not warranted, and that management problems and liability risks can be reduced by following established published guidelines (eg, from the American Academy of Pain Medicine and American Pain Society [1996]5 and the Federation of State Medical Boards of the United States Inc [1998]6). Furthermore, high-risk patients for opioid prescriptions may already have overt substance abuse, psychopathologic conditions, multiple and ill-defined complaints, and drug-seeking behaviors that alert physicians either to not prescribe these drugs or to do so within very strict guidelines. However, other authors, typically from an addiction medicine perspective, have cited the medical, psychological, and social difficulties inherent in long-term opioid prescribing.7-10 Furthermore, the risk of drug diversion for “street” use may concern practitioners because nonmedicinal use of opioids has increased substantially among street-drug abusers.11 Hence, long-term prescribing of opioid drugs for the managementof chronic, nonmalignant pain may seem necessary but typically remains worrisome for physicians who either start or are obliged to continue this course of treatment.