B. Eliot Cole, MD, MPA

A recent study found states that allowed the use of medicinal marijuana had substantially lower opioid overdose mortality rates compared with states that do not have medical cannabis laws.

Looking back over a 30-year career in pain medicine, the author laments the shift from comprehensive, multidisciplinary pain care to a model that focuses on pills and procedures to treat chronic pain.

Rescheduling hydrocodone combination products to the more-restrictive schedule II will impact clinicians and patients suffering with chronic pain, but will it have the desired effect on the misuse and abuse of these products?

Abuse-deterrent properties, identical efficacy for pain relief, reversal of opioid-induced constipation, and theoretical tolerance mitigation may give Targiniq ER an interesting advantage over other oral opioids.

Do National Prescription Drug Takeback Programs really make an impact on opioid misuse and diversion? Why doesn't the DEA go after people who overdose on opioids that were probably diverted?

Following the approval of Zohydro last year, attorneys general across the country requested the FDA reconsider its decision until the medication could be reformulated to include abuse-deterrent properties. Now, two states have moved to reduce access to Zohydro. Will the courts uphold these decisions, or will other states follow in their wake?

The newly approved naloxone auto-injector has the potential to save many lives, but should not be viewed as the Holy Grail of the ongoing fight to prevent overdose deaths from opioid abuse and misuse.

While the peak of the opioid epidemic may now have been reached (according to some), we are not out of the woods. Every decision to start or continue opioid therapy must be careful, deliberate, and weigh benefit against risk, while keeping in mind that risk is not constant/static, but dynamic and evolves through time.

Acetaminophen toxicity is the second most common cause of liver failure requiring transplantation in the US.

Will the approval of Zohydro benefit patients and physicians by providing another option for pain relief for patients with legitimate chronic pain needs, or will it spark a new wave of abuse, misuse, and diversion?

The new Federation of State Medical Boards Model Policy for the Use of Opioid Analgesics in the Treatment of Chronic Pain is designed to help ensure physicians who prescribe or use opioids do so "in full compliance with state and federal regulations, accepted clinical practice, and in a manner that is safe and reduces risk."

With what we now know about opioid misuse and abuse, we need to take the necessary steps to ensure that only abuse-resistant/deterrent medications are used for our patients taking ER/LA opioid medications.

Declaring that the benefits of the original formulation of OxyContin no longer outweigh the risks of misuse and abuse, the FDA announced it would not approve any applications for non-tamper resistant formulations of the drug, a decision that could have far-reaching implications for all makers of opioid medications.

Promising advances in research hint at the day when truly tailored pain management will be possible, allowing us to move past our current model of treatment.

The push to provide better pain care and ensure adequate analgesia for patients living with chronic pain led to liberalized opioid prescription practices that have been accompanied by a massive increase in the abuse, misuse, and diversion of prescription opioids. Efforts to combat this include technological remedies such as "abuse-deterrent" formulations of opioids and educational approaches such as the REMS program approved by the FDA in 2012.

The Canadian government's recent decision to allow the sale of a generic version of the original formulation of OxyContin could have serious consequences for efforts to curb opioid abuse, misuse, and diversion in the US.

With most medical schools devoting only a few curriculum hours to pain management training, many physicians begin their medical career underprepared to meet the needs of patients suffering with chronic pain. Here, Barry Cole, MD, identifies several key concepts that would help improve pain care in the US if only more physicians would learn about them sooner.

Recently, a group calling itself Physicians for the Responsible Opioid Prescribing proposed several radical changes to the way we treat patients with chronic noncancer pain, calling for limits on the dose and duration of opioid treatment that would in effect deny these medications to the majority of patients now receiving them for noncancer pain.