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The Prescription Opioid Epidemic: Challenges and Opportunities for California Pain Physicians
By Ramana Naidu, MD and Mark Schumacher, MD, PhD

Depending on your practice, you may have been hoping for or fearing the day when all turn and ask, “Why are ever-increasing doses of opioids being used to treat chronic non-cancer pain?”

With the first national guidelines on opioid prescribing, that day is upon us, and many are scrambling to provide an evidence-based response to our patients, professional societies, and government regulatory services. The issue here is not simply whether or not there is sufficient evidence that long-term opioid use for non-cancer pain improves pain and quality of life. In fact, there is little if any evidence of benefit past one to three months of use, and a growing burden of morbidity and mortality.   

How do we proceed in the face of daily news briefs intended to improve the safety of opioid-based pain care, when we see a patient today who has been taking over 300 oral morphine equivalents daily for the past three years? 

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