AAPM RELEASES STATEMENT ON THE
DIVERSION AND ABUSE
OF CONTROLLED SUBSTANCES




AAPM
4700 W. Lake Avenue
Glenview, IL 60025-1485
847/375-4731 Fax 877/734-8750
e-mail: [email protected]
Web site: http//www.painmed.org/

FOR IMMEDIATE RELEASE
Contact: Kris Haskin
847/375-4731

Miami Beach, FL � February 16, 2001 This official position statement is issued at the annual meeting of the American Academy of Pain Medicine, the organization representing physicians who specialize in the practice of Pain Medicine.

We are very concerned and strongly opposed to the diversion and abuse of controlled substances and support law enforcement efforts to stop these criminal activities. However, there is an issue of greater importance to public health resulting from the inadequate treatment of patients with serious pain disorders.

To help prevent these problems, the American Academy of Pain Medicine worked with the U.S. Congress to declare this the Decade of Pain Control and Research, worked with the Federation of State Medical Boards to create a clinical guideline for the appropriate use of opioid medications in treating pain, and is developing an educational program for primary care professionals on pain assessment, opioid usage, and detection of addiction and prevention of diversion.

Millions of people have suffered unnecessarily because of barriers to effective pain treatment. Exaggerated and unrealistic fears of addiction are paramount among these barriers, which should not be re-erected in response to publicity regarding drug abuse. Physicians should not be afraid to provide adequate analgesia when able to do so, and patients with acute pain or pain from cancer, AIDS, and other serious diseases should not fear the use of opioids, which are safe when used appropriately.

Experience and investigation have shown that when opioids are prescribed and used appropriately in the treatment of pain there is minimal danger of creating an addictive disorder. Evidence to date indicates that substance abuse problems have not increased as a result of the increased availability of therapeutic opioids. The public health problem represented by misuse of prescription opioids is miniscule in comparison with that of untreated and unrelenting pain.




DEFINITIONS RELATED TO THE

USE OF OPIOIDS FOR THE TREATMENT OF PAIN



� 2001 American Academy of Pain Medicine, American Pain Society and American Society of Addiction Medicine

A consensus document from the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine.

BACKGROUND

Clear terminology is necessary for effective communication regarding medical issues. Scientists, clinicians, regulators, and the lay public use disparate definitions of terms related to addiction. These disparities contribute to a misunderstanding of the nature of addiction and the risk of addiction, especially in situations in which opioids are used, or are being considered for use, to manage pain.

Confusion regarding the treatment of pain results in unnecessary suffering, economic burdens to society, and inappropriate adverse actions against patients and professionals.

Many medications, including opioids, play important roles in the treatment of pain. Opioids, however, often have their utilization limited by concerns regarding misuse, addiction, and possible diversion for non-medical uses.

Many medications used in medical practice produce dependence, and some may lead to addiction in vulnerable individuals. The latter medications appear to stimulate brain reward mechanisms; these include opioids, sedatives, stimulants, anxiolytics, some muscle relaxants, and cannabinoids.

Physical dependence, tolerance, and addiction are discrete and different phenomena that are often confused. Since their clinical implications and management differ markedly, it is important that uniform definitions, based on current scientific and clinical understanding, be established in order to promote better care of patients with pain and other conditions where the use of dependence-producing drugs is appropriate, and to encourage appropriate regulatory policies and enforcement strategies.




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