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Opioid Therapy for Chronic Nonmalignant Pain: Clinicians' Perspective

Published online by Cambridge University Press:  01 January 2021

Russell K. Portenoy
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During the past decade, debate has intensified about the role of long-term opioid therapy in the management of chronic nonmalignant pain. Specialists in pain management have discussed the issues extensively and now generally agree that a selected population of patients with chronic pain can attain sustained analgesia without significant adverse consequences. This perspective, however, is not uniformly accepted by pain specialists and has not been widely disseminated to other disciplines or the public. Rather, the more traditional perspective, which ascribes both transitory benefit and substantial cumulative risk to long-term opioid therapy, continues to predominate. According to this perspective, the inevitability of tolerance limits the possibility of sustained efficacy, and other pharmacological properties increase the likelihood of adverse outcomes, including persistent side-effects, impairment in physical and psychosocial functioning, and addiction. If accurate, these outcomes would indeed justify the withholding of opioid therapy for all but the most extreme cases of chronic nonmalignant pain.

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Journal of Law, Medicine & Ethics , Volume 24 , Issue 4 , Winter 1996 , pp. 296 - 309
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Copyright © American Society of Law, Medicine and Ethics 1996

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References

A consensus statement that acknowledges the acceptance of opioid therapy in selected patients has been endorsed by the boards of directors of both the American Pain Society and the American Academy of Pain Specialists. To evaluate the preceding debate in the pain literature, see Brena, S.F. Sanders, S.H., “Opioids in Nonmalignant Pain: Questions in Search of Answers,” Clinical Journal of Pain, 7 (1991): 342-45; Chabal, C.et al, “Narcotics for Chronic Pain: Yes or No? A Useless Dichotomy,” American Fain Society Journal, 1 (1991): 276–81; Chabal, C.et al, “The Psychosocial Impact of Opioid Treatment,” American Pain Society Journal, 1 (1992): 289–91; Fordyce, W.E., “Opioids, Pain and Behavioral Outcomes,” American Pain Society Journal, 1 (1992): 282–84; Glynn, C.J.et al, “Opioids in Nonmalignant Pain: Questions in Search of Answers,” Clinical Journal of Pain, 7 (1991): 346; Gourlay, G.K. Cherry, D.A., “Can Opioids Be Successfully Used to Treat Severe Pain in Nonmalignant Conditions?,” Clinical Journal of Pain, 7 (1991): 347–49; Merry, A.F.et al, “Opioids in Chronic Pain of Nonmalignant Origin: State of the Debate in New Zealand,” European Journal of Pain, 13 (1992): 39–43; Newman, R.G., “The Need to Redefine Addiction,” N. Engl. J. Med., 18 (1983): 1096–98; Portenoy, R.K., “Opioid Therapy in the Management of Chronic Back Pain,” in Tollison, C.D., ed., Interdisciplinary Rehabilitation of Low Back Pain (Baltimore: Williams & Wilkins, 1989): 137–58; Portenoy, R.K., “Opioid Therapy in Nonmalignant Pain,” Journal of Pain and Symptom Management, 5 (1990): S46–S62; Portenoy, R.K., “Chronic Opioid Therapy for Persistent Noncancer Pain: Can We Get Past the Bias?,” American Pain Society Bulletin, 1 (1991): 1–5; Portenoy, R.K., “Inadequate Outcome of Cancer Pain Treatment: Influences on Patient and Clinician Behavior,” in Part, R.B., ed., Problems in Cancer Pain Management: A Comprehensive Approach (Philadelphia: J.B. Lippincott, 1992): 119–28; Portenoy, R.K., “Opioid Therapy for Chronic Nonmalignant Pain: Current Status,” in Fields, H.L. Liebeskind, J.C., eds., Progress in Pain Research and Management (Seattle: IASP Press, Vol. 1, 1994): 247–87; Portenoy, R.K., “Opioid Therapy for Chronic Nonmalignant Pain: A Review of the Critical Issues,” Journal of Pain and Symptom Management, 11 (1996): 203–17; Portenoy, R.K. Payne, R., “Acute and Chronic Pain,” in Lowinson, J.H. Ruiz, P. Millman, R.B., eds., Substance Abuse: A Comprehensive Textbook (Baltimore: Williams & Wilkins, 1992): 691–721; Savage, S.R., “Addiction in the Treatment of Pain: Significance, Recognition, and Management,” Journal of Pain and Symptom Management, 8 (1993): 265–78; Schofferman, J., “Long-Term Use of Opioid Analgesics for the Treatment of Chronic Pain of Nonmalignant Origin,” Journal of Pain and Symptom Management, 8 (1993): 279–88; Schug, S.A. Merry, A.F. Acland, R.H., “Treatment Principles for the Use of Opioids in Pain of Nonmalignant Origin,” Drugs, 42 (1991): 228–39; Taub, A., “Opioid Analgesics in the Treatment of Chronic Intractable Pain of Non-Neoplastic Origin,” in Kitahata, L.M. Collins, D., eds., Narcotic Analgesics in Anesthesiology (Baltimore: Williams & Wilkins, 1982): 199–208; Zenz, M., “Morphine Myths: Sedation, Tolerance, Addiction,” Postgraduate Medical Journal, 67 (1991): S100–S102; and Hagen, N.et al, “Guidelines for Managing Chronic Non-Malignant Pain,” Canadian Family Physician Medicine, 41 (1995): 49–53.10.1097/00002508-199112000-00015CrossRefGoogle ScholarPubMed
Bonica, J.J., “Treatment of Cancer Pain: Current Status and Future Needs,” in Fields, H.L. Dubner, R. Cervero, R., eds., Advances in Pain Research and Therapy (New York: Raven Press, Vol. 9, 1985): 589–616; Jorgensen, L.et al, “Treatment of Cancer Pain Patients in a Multidisciplinary Pain Clinic,” Pain Clinic, 3 (1990): 83–89; Moulin, D.E. Foley, K.M., “Review of a Hospital-Based Pain Service,” in Foley, K.M. Bonica, J.J. Ventafridda, V., eds., Advances in Pain Research and Therapy, Second International Congress on Cancer Pain (New York: Raven Press, Vol. 16, 1990): 413–27; Portenoy, R.K., “Cancer Pain: Epidemiology and Syndromes,” Cancer, 63 (1989): 2298–307; Schug, S.A. Zech, D. Dorr, U., “Cancer Pain Management According to WHO Analgesic Guidelines,” Journal of Pain and Symptom Management, 5 (1990): 27–32; Schug, S.A.et al, “A Long-Term Survey of Morphine in Cancer Pain Patients,” Journal of Pain and Symptom Management, 7 (1992): 259–66; Takeda, F., “Results of Field Testing in Japan of the WHO Draft Interim Guidelines on Relief of Cancer Pain,” Pain Clinic, 1 (1986): 83–89; Toscani, F. Carini, M., “The Implementation of WHO Guidelines for the Treatment of Advanced Cancer Pain at a District General Hospital in Italy,” Pain Clinic, 3 (1989): 37–48; Ventafridda, V. Tamburini, M. DeConno, F., “Comprehensive Treatment in Cancer Pain,” in Fields, H.L. Dubner, R. Cervero, F., eds., Advances in Pain Research and Therapy (New York: Raven Press, Vol. 9, 1985): 617–28; Ventafridda, V.et al, “A Validation Study of the WHO Method for Cancer Pain Relief,” Cancer, 59 (1987): 850–56; Vijayaram, S.et al, “Experience with Oral Morphine for Cancer Pain Relief,” Journal of Pain and Symptom Management, 4 (1989): 130–34; Walker, V.A.et al, “Evaluation of WHO Analgesic Guidelines for Cancer Pain in a Hospital-Based Palliative Care Unit,” Journal of Pain and Symptom Management, 3 (1988): 145–49; World Health Organization, Cancer Pain Relief (Geneva: World Health Organization, 1986); World Health Organization, Cancer Pain Relief and Palliative Care (Geneva: World Health Organization, 1990); and World Health Organization, Cancer Pain Relief, With a Guide to Opioid Availability (Geneva: World Health Organization, 2nd ed., 1996).Google Scholar
Portenoy, R.K., “Pain and Quality of Life: Theoretical Aspects,” in Osoba, D., ed., Quality of Life in Cancer Patients (New York: CRC Publ., 1991): 279-92; and Ventafridda, V.et al, “Pain and Quality of Life Assessment in Advanced Cancer Patients,” in Ventafridda, V.et al, eds., Assessment of Quality of Life and Cancer Treatment (Amsterdam: Excerpta Medica, 1986): 183–92.Google Scholar
American Pain Society, Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain (Skokie: American Pain Society, 3rd ed., 1992); Angell, M., “The Quality of Mercy,” N. Engl. J. Med., 306 (1982): 98–99; Foley, K.M., “The Relationship of Pain and Symptom Management to Patient Requests for Physician-Assisted Suicide,” Journal of Pain and Symptom Management, 6 (1991): 289–97; Health and Public Policy Committee, American College of Physicians, “Drug Therapy for Severe Chronic Pain in Terminal Illness,” Annals of Internal Medicine, 99 (1983): 870–73; McGivney, W.T. Crooks, G.M., “The Care of Patients with Severe Chronic Pain in Terminal Illness,” JAMA, 251 (1984): 1182–88; Morgan, J.P., “American Opiophobia: Customary Underutilization of Opioid Analgesics,” Advances in Alcohol and Substance Abuse, 5 (1985): 163–73; Portenoy, (1992), supra note 1; Stjernsward, J., “Cancer Pain Relief: An Important Global Public Health Issue,” in Fields, H.L. Dubner, R. Cervero, F., eds., Advances in Pain Research and Therapy (New York: Raven Press, Vol. 9, 1985): 555–58; Swerdlow, M. Stjernsward, J., “Cancer Pain Relief—An Urgent Problem,” World Health Forum, 3 (1982): 325–30; World Health Organization (1986), supra note 2; World Health Organization (1990), supra note 2; World Health Organization (1996), supra note 2; and Zenz, M. Sorge, J., “Is the Therapeutic Use of Opioids Adversely Affected by Prejudice and Law?,” Recent Results in Cancer Research, 121 (1991): 43–50.10.1056/NEJM198201143060210CrossRefGoogle ScholarPubMed
Clark, H.W. Sees, K.L., “Opioids, Chronic Pain and the Law,” Journal of Pain and Symptom Management, 8 (1993): 297–305; Haislip, G.R., “Impact of Drug Abuse on Legitimate Drug Use,” in Hill, C.S. Fields, W.S., eds., Advances in Pain Research and Therapy (New York: Raven Press, Vol. 11, 1989): 205–11; and Hill, C.S., “Influence of Regulatory Agencies on the Treatment of Pain and Standards of Medical Practice for the Use of Narcotics,” Pain Digest, 1 (1991): 7–12.10.1016/0885-3924(93)90158-RCrossRefGoogle Scholar
Angarola, R.T. Wray, S.D., “Legal Impediments to Cancer Pain Treatment,” in Hill, C.S. Fields, W.S., eds., Advances in Pain Research and Therapy (New York: Raven Press, Vol. 11, 1989): 213-31; Edwards, W.T., “Optimizing Opioid Treatment of Postoperative Pain,” Journal of Pain and Symptom Management, 5 (1990): S24–S36; Hill, C.S., “Relationship Among Cultural, Educational and Regulatory Agency Influence on Optimum Cancer Pain Treatment,” Journal of Pain and Symptom Management, 5 (1990): S37–S45; Hill, , supra note 5; Morgan, , supra note 4; Portenoy (1992), supra note 1; and Zenz, Sorge, , supra note 4.Google Scholar
Weissman, D.E. Joranson, D.E. Hopwood, M.B., “Wisconsin Physicians' Knowledge and Attitudes About Opioid Analgesic Regulations,” Wisconsin Medical Journal, 90 (1991): 671-75.Google Scholar
Gitchel, G.T., “Existing Methods to Identify Retail Drug Diversion,” in Cooper, J.R. Czechowicz, D.J. Molinari, S.P., eds., Impact of Prescription Drug Diversion Control Systems on Medical Practice and Patient Care (Washington, D.C.: U.S. Government Printing Office, National Institute on Drug Abuse, Research Mono. 131, 1993): 132-40.Google Scholar
United States Department of Justice, Drug Enforcement Administration: Multiple Copy Prescription Program Resource Guide (Washington, D.C.: U.S. Government Printing Office, 1987).Google Scholar
Angarola, Wray, , supra note 6; Cooper, J.R.et al, “Prescription Drug Diversion Control and Medical Practice,” JAMA, 268 (1992): 1306-10; Portenoy, R.K., “The Effect of Drug Regulation on the Management of Cancer Pain,” New York State Journal of Medicine, 91 (1991): 13S–18S; and Reidenberg, M.M., “Effect of the Requirement for Triplicate Prescriptions for Benzodiazepines in New York State,” Clinical Pharmacology and Therapeutics, 50 (1991): 129–31.Google Scholar
Jacob, T.R., “Multiple Copy Prescription Regulation and Drug Abuse: Evidence from the DAWN Network,” in Wilford, B.B., ed., Balancing the Response to Prescription Drug Abuse (Chicago: American Medical Association, 1990): 205-17.Google Scholar
Sigler, K.A.et al, “Effects of a Triplicate Prescription Law on Prescribing of Schedule II Drugs,” American Journal of Hospital Pharmacology, 41 (1984): 108-11; and Weintraub, M.et al, “Consequences of the 1989 New York State Triplicate Benzodiazepine Prescription Regulations,” JAMA, 266 (1991): 2392–97.Google Scholar
Joranson, D.E.et al, “Opioids for Chronic Cancer and Non-Cancer Pain: A Survey of State Medical Board Members,” Federal Bulletin, 4 (1992): 15–49.Google Scholar
Thurel, C. Bardin, T. Boccard, E., “Analgesic Efficacy of an Association of 500 mg Paracetamol Plus 30 mg Codeine Versus 400 mg Paracetamol Plus 30 mg Dextropropoxyphene in Repeated Doses for Chronic Lower Back Pain,” Current Therapy and Research, 50 (1991) 463-73; Vlok, G.J. Van Vuren, J.P., “Comparison of a Standard Ibuprofen Treatment Regimen with a New Ibuprofen/Paracetamol/Codeine Combination in Chronic Osteoarthritis,” South Africa Medical Journal, 1 Supp. (1987): 1–6; Arkinstall, W.et al, “Efficacy of Controlled-Release Codeine in Chronic Non-Malignant Pain: A Randomized, Placebo-Controlled Clinical Trial,” Pain, 62 (1995): 169–78; Boissier, C.et al, “Acceptability and Efficacy of Two Associations of Paracetamol with a Central Analgesic (Dextropropoxyphene or Codeine): Comparison in Osteoarthritis,” Journal of Clinical Pharmacology, 32 (1992): 990–95; and Lloyd, R.S.et al, “The Efficacy and Tolerability of Controlled-Release Dihydrocodeine Tablets and Combination Dextro-propoxyphene Paracetamol Tablets in Patients with Severe Osteoarthritis of the Hips,” Current Medical Research Opinion, 13 (1992): 37–48.Google Scholar
Moulin, D.E.et al, “Randomised Trial of Oral Morphine for Chronic Non-Cancer Pain,” Lancet, 347 (1996): 143-47.10.1016/S0140-6736(96)90339-6CrossRefGoogle Scholar
Brookoff, D. Palomano, R., “Treating Sickle Cell Pain Like Cancer Pain,” Annals of Internal Medicine, 116 (1992): 364-68. France, R.D. Urban, B.J. Keefe, F.J., “Long-Term Use of Narcotic Analgesics in Chronic Pain,” Social Science and Medicine, 19 (1984): 1379–82; Green, J. Coyle, M., “Methadone Use in the Control of Nonmalignant Chronic Pain,” Pain Management, Sept./Oct. (1989): 241–46; Krames, E.S. Lanning, R.M., “Intrathecal Infusional Analgesia for Nonmalignant Pain: Analgesic Efficacy of Intrathecal Opioid With or Without Bupivacaine,” Journal of Pain and Symptom Management, 8 (1993): 539–48; Plummer, J.L.et al, “Long-Term Spinal Administration of Morphine in Cancer and Non-Cancer Pain: A Retrospective Study,” Pain, 44 (1991): 215–20; Portenoy, (1990), supra note 1; Portenoy, R.K. Foley, K.M., “Chronic Use of Opioid Analgesics in Non-Malignant Pain: Report of 38 Cases,” Pain, 25 (1986): 171–86; Taub, , supra note 1; Tennant, F.S. Uelman, G.F., “Narcotic Maintenance for Chronic Pain: Medical and Legal Guidelines,” Postgraduate Medicine, 73 (1983): 81–94; Tennant, F.S.et al, “Chronic Opioid Treatment of Intractable Non-Malignant Pain,” Pain Management, Jan./Feb. (1988): 18–36; Urban, B.J.et al, “Long-Term Use of Narcotic-Antidepressant Medication in the Management of Phantom Limb Pain,” Pain, 24 (1986): 191–97; and Zenz, M. Strumpf, M. Tryba, M., “Long-Term Opioid Therapy in Patients with Chronic Nonmalignant Pain,” Journal of Pain and Symptom Management, 7 (1992): 69–77.10.7326/0003-4819-116-5-364CrossRefGoogle Scholar
See Zenz, Strumpf, Tryba, , id.Google Scholar
See Brookoff, Palomano, , supra note 16.Google Scholar
Buckley, F.P. Sizemore, W.A. Charlton, J.E., “Medication Management in Patients with Chronic Non-Malignant Pain. A Review of the Use of a Drug Withdrawal Protocol,” Pain, 26 (1986): 153-66; Finlayson, R.D. Maruta, T. Morse, B.R., “Substance Dependence and Chronic Pain: Profile of 50 Patients Treated in an Alcohol and Drug Dependence Unit,” Pain, 26 (1986): 167–74; Finlayson, R.D.et al, “Substance Dependence and Chronic Pain: Experience with Treatment and Follow-Up Results,” Pain, 26 (1986): 175–80; Maruta, T., “Prescription Drug-Induced Organic Brain Syndrome,” American Journal of Psychiatry, 135 (1978): 376–77; Maruta, T. Swanson, D.W., “Problems with the Use of Oxycodone Compound in Patients with Chronic Pain,” Pain, 11 (1981): 389–96; Maruta, T. Swanson, D.W. Finlayson, R.E., “Drug Abuse and Dependency in Patients with Chronic Pain,” Mayo Clinic Proceedings, 54 (1979): 241–44; McNairy, S.L.et al, “Prescription Medication Dependence and Neuropsychologic Function,” Pain, 18 (1984): 169–77; Ready, L.B. Sarkis, E. Turner, J.A., “Self-Reported vs. Actual Use of Medications in Chronic Pain Patients,” Pain, 12 (1982): 285–94; and Turner, J.A.et al, “Drug Utilization Pattern in Chronic Pain Patients,” Pain, 12 (1982): 357–63.10.1016/0304-3959(86)90071-0CrossRefGoogle Scholar
See Portenoy, (1990), supra note 1.Google Scholar
Galer, B.S.et al, “Individual Variability in the Response to Different Opioids: Report of Five Cases,” Pain, 49 (1992): 87–91.10.1016/0304-3959(92)90192-ECrossRefGoogle Scholar
Bruera, E.et al, “The Edmonton Staging System for Cancer Pain: Preliminary Report,” Pain, 37 (1989): 203-10; and Mercadante, S.et al, “Predictive Factors in Advanced Cancer Pain Treated Only by Analgesics,” Pain, 50 (1992): 151–55.10.1016/0304-3959(89)90131-0CrossRefGoogle Scholar
Amer, S. Meyerson, B.A., “Lack of Analgesic Effect of Opioids on Neuropathic and Idiopathic Forms of Pain,” Pain, 33 (1988): 11–23; Bruera, et al, id.; Kupers, R.C.et al, “Morphine Differentially Affects the Sensory and Affective Pain Ratings in Neurogenic and Idiopathic Forms of Pain,” Pain, 47 (1991): 5–12; and Moulin, Foley, , supra note 2.Google Scholar
Cherny, N.I.et al, “Opioid Responsiveness of Cancer Pain Syndromes Caused by Neuropathic or Nociceptive Mechanisms: A Combined Analysis of Controlled Single Dose Studies,” Neurology, 44 (1994): 857-61; Galer, et al, supra note 21; Jadad, A.R.et al, “Morphine Responsiveness of Chronic Pain: Double-Blind Randomised Crossover Study with Patient-Controlled Analgesia,” Lancet, 339 (1992): 1367–71; McQuay, H.J.et al, “Opioid Sensitivity of Chronic Pain: A Patient-Controlled Analgesia Method,” Anaesthesia, 47 (1992): 757–67; Mercadante, et al, supra note 22; Portenoy, (1990), supra note 1; Portenoy, Foley, , supra note 16; Rowbotham, M.C. Reisner-Keller, L.A. Fields, H.L., “Both Intravenous Lidocaine and Morphine Reduce the Pain of Postherapeutic Neuralgia,” Neurology, 41 (1991): 1024–28; Urban, et al, supra note 16; and Zenz, Strumpf, Tryba, , supra note 16.10.1212/WNL.44.5.857CrossRefGoogle Scholar
Louie, A.K. Way, E.L., “Overview of Opiate Tolerance and Physical Dependence,” in Almeida, O.F. Shippenberg, T.S., eds., Neurobiology of Opioids (New York: Springer-Verlag, 1991).Google Scholar
See Portenoy, (1989), supra note 1.Google Scholar
Brescia, F.J.et al, “Pain, Opioid Use and Survival in Hospitalized Patients with Advanced Cancer,” Journal of Clinical Oncology, 10 (1992): 149-55; Foley, K.M., “Changing Concepts of Tolerance to Opioids: What the Cancer Patient Has Taught Us,” in Chapman, C.R. Foley, K.M., eds., Current and Emerging Issues in Cancer Pain: Research and Practice (New York: Raven Press, 1993): 331–50; France, Urban, Keefe, , supra note 16; Hill, , supra note 6; Kanner, R.M. Foley, K.M., “Patterns of Narcotic Drug Use in a Cancer Pain Clinic,” Annals of the New York Academy of Science, 362 (1981): 161–72; Krames, Lanning, , supra note 16; Onofrio, B.M. Yaksh, T.L., “Long-Term Pain Relief Produced by Intrathecal Morphine Infusion in 53 Patients,” Journal of Neurosurgery, 72 (1990): 200–09; Plummer, et al, supra note 16; Portenoy, Foley, , supra note 16; Schug, et al, supra note 1; Taub, , supra note 1; Twycross, R.G., “Clinical Experience with Diamorphine in Advanced Malignant Disease,” International Journal of Optical Pharmacology, Therapy and Toxicology, 9 (1974): 184–98; and Urban, et al, supra note 16.10.1200/JCO.1992.10.1.149CrossRefGoogle Scholar
Chapman, C.R. Aola, A.E. Bonica, J.J., “Illness Behavior and Depression in Pain Center and Private Practice Patients,” Pain, 6 (1979): 1–7; Crook, J. Tunks, E., “Defining the ‘Chronic Pain Syndrome’: An Epidemiological Method,” in Fields, H.L. Dubner, R. Cervero, R., eds., Advances in Pain Research and Therapy (New York: Raven Press, Vol. 9, 1985): 871–78; Crook, J.et al, “Epidemiologic Comparison of Persistent Pain Sufferers in a Specialty Pain Clinic and in the Community,” Archives of Physics, Medicine and Rehabilitation, 67 (1986): 451–55; Crook, J. Weir, R. Tunks, E., “An Epidemiological Follow-Up Survey of Persistent Pain Sufferers in a Group Family Practice and Specialty Pain Clinic,” Pain, 36 (1989): 49–61; Deyo, R.A.et al, “Prognostic Variability Among Chronic Pain Patients: Implications for Study Design, Interpretation, and Reporting,” Archives of Physical Medicine and Rehabilitation, 69 (1988): 174–78; and Pilowsky, I. Chapman, C.R. Bonica, J.J., “Pain, Depression, and Illness Behavior in a Pain Clinic Population,” Pain, 4 (1977): 183–92.10.1016/0304-3959(79)90135-0CrossRefGoogle Scholar
Turk, D.C. Rudy, T.E., “Neglected Topics in the Treatment of Chronic Pain Patients—Relapse, Noncompliance and Adherence Enhancement,” Pain, 44 (1991): 5–28.10.1016/0304-3959(91)90142-KCrossRefGoogle Scholar
Bruera, E. Miller, M.J., “Non-Cardiogenic Pulmonary Edema After Narcotic Treatment for Cancer Pain,” Pain, 39 (1989): 297–300.10.1016/0304-3959(89)90043-2CrossRefGoogle Scholar
Kreek, M.J., “Medical Safety and Side-Effects of Methadone in Tolerant Individuals,” JAMA, 223 (1973): 665-68; and Kreek, M.J., “Medical Complications in Methadone Patients,” Annals of the New York Academy of Science, 311 (1978): 110–34.10.1001/jama.1973.03220060039009CrossRefGoogle ScholarPubMed
Arora, P.K.et al, “Morphine-Induced Immune Alterations In Vivo,” Cell Immunology, 126 (1990): 343-53; Donohoe, R.M.et al, “Morphine Depression of T Cell E-Rosetting: Definition of the Process,” Federal Procedures, 44 (1985): 95–99; Einstein, T.K.et al, “Immunosuppression to Tetanus Toxoid Induced by Implanted Morphine Pellets,” Annals of the New York Academy of Science, 594 (1990): 377–79; Molitor, T.W.et al, “Chronic Morphine Administration Impairs Cell-Mediated Immune Responses in Swine,” Journal of Pharmacology and Experimental Therapeutics, 260 (1992): 581–086; Peterson, P.K.et al, “Opioid-Mediated Suppression of Interferon-Production by Cultured Peripheral Blood Mononuclear Cells,” Journal of Clinical Investigations, 80 (1987): 824–31; Shavit, Y.et al, “Opioid Peptides Mediate the Suppressive Effect of Stress on Natural Killer Cell Cytotoxicity,” Science, 223 (1984): 188–90; and Weber, R.J.et al, “Opiate Receptor Mediated Regulation of the Immune Response In Vivo,” National Institute of Drug Abuse (Washington, D.C.: U.S. Government Printing Office, National Institute on Drug Abuse, Research Mono. 76, 1987): 341–48.10.1016/0008-8749(90)90326-MCrossRefGoogle Scholar
See Kreek, (1973), supra note 31; and Kreek, (1978), supra note 31.Google Scholar
Zacny, J.P., “A Review of the Effects of Opioids on Psychomotor and Cognitive Functioning in Humans,” Experimental Clinical Psychopharmacology, 3 (1995): 432-66.Google Scholar
Sjogren, P. Banning, A., “Pain, Sedation and Reaction Time During Long-Term Treatment of Cancer Patients with Oral and Epidural Opioids,” Pain, 39 (1989): 5–12; and Banning, A. Sjogren, P., “Cerebral Effects of Long-Term Oral Opioids in Cancer Patients Measured by Continuous Reaction Time,” Clinical Journal of Pain, 6 (1990): 91–95.Google Scholar
Vainio, A.et al, “Driving Ability in Cancer Patients Receiving Long-Term Morphine Analgesia,” Lancet, 346 (1995): 667-70.10.1016/S0140-6736(95)92281-4CrossRefGoogle Scholar
See Bruera, et al, supra note 22.Google Scholar
McNairy, et al, supra note 19; Maruta, , supra note 19; Rounsaville, B.H.et al, “Neuropsychological Impairment in Opiate Addicts: Risk Factors,” Annals of the New York Academy of Science, 362 (1981): 79–90; Martin, W.R.et al, “Methadone—A Reevaluation,” Archives of General Psychiatry, 28 (1973): 286–95; and Haertzen, C.A. Hooks, N.T., “Changes in Personality and Subjective Experience Associated with the Chronic Administration and Withdrawal of Opiates,” Journal of Nerves and Mental Disease, 148 (1969): 606–14.Google Scholar
Hendler, N.et al, “A Comparison of Cognitive Impairment Due to Benzodiazepines and to Narcotics,” American Journal of Psychiatry, 137 (1980): 828-30; Appel, P.W. Gordon, N.B., “Digit-Symbol Performance in Methadone-Treated Ex-Heroin Addicts,” American Journal of Psychiatry, 133 (1976): 1337–40; and Lombardo, W.K. Lombardo, B. Goldstein, A., “Cognitive Functioning Under Moderate and Low Dose Methadone Maintenance,” International Journal of Addiction, 11 (1976): 389–401.Google Scholar
Gordon, N.B., “Influence of Narcotic Drugs on Highway Safety,” Accident Analysis Preview, 8 (1976): 3–7; and Babst, D.V.et al, Driving Records of Methadone Maintained Patients in New York State (Albany: New York State Narcotic Control Commission, 1973).CrossRefGoogle Scholar
Dole, V.P., “Narcotic Addiction, Physical Dependence and Relapse,” N. Engl. J. Med., 286 (1972): 988-92; Martin, W.R. Jasinski, D.R., “Physiological Parameters of Morphine Dependence in Man-Tolerance, Early Abstinence, Protracted Abstinence,” Journal of Psychology Research, 7 (1969): 9–17; and Rinaldi, R.C.et al, “Clarification and Standardization of Substance Abuse Terminology,” JAMA, 259 (1988): 555–57.10.1056/NEJM197205042861808CrossRefGoogle Scholar
World Health Organization, Technical Report No. 516, Youth and Drugs (Geneva: World Health Organization, 1973); and American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (Washington, D.C.: American Psychiatric Association, 4th ed., 1994).Google Scholar
Wilder, A., Opioid Dependence: Mechanisms and Treatment (New York: Plenum Press, 1980).Google Scholar
Buckley, Sizemore, Charlton, , supra note 19; Halpern, L.M. Robinson, J., “Presenting Practices for Pain in Drug Dependence: A Lesson in Ignorance,” Advanced Alcohol Substance Abuse, 5 (1985): 184-97; and Kanner, Foley, , supra note 27.Google Scholar
Dai, S.et al, “Heroin Self-Administration by Rats: Influence of Dose and Physical Dependence,” Pharmacology, Biochemistry, Behavior, 32 (1989): 1009-15.CrossRefGoogle Scholar
Brodner, R.A. Taub, A., “Chronic Pain Exacerbated by Long-Term Narcotic Use in Patients with Nonmalignant Disease: Clinical Syndrome and Treatment,” Mount Sinai Journal of Medicine, 45 (1978): 233-37; and Schofferman, , supra note 1.Google Scholar
Matthew, N., “Drug-Induced Headache,” Neurologic Clinics, 8 (1990): 903-12; and Saper, J.R., “Daily Chronic Headache,” Neurologic Clinics, 8 (1990): 891–902.Google Scholar
Jaffe, J.H., “Drug Addiction and Drug Abuse,” in Gilman, A.G.et al, eds., The Pharmacological Basis of Therapeutics (New York: Macmillan, 7th ed., 1985): 532-81.Google Scholar
World Health Organization, supra note 42.Google Scholar
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (Washington, D.C.: American Psychiatric Association, 3rd ed., rev., 1987); and American Psychiatric Association, supra note 42.Google Scholar
See Clark, Sees, , supra note 5.Google Scholar
See Rinaldi, et al, supra note 41.Google Scholar
See Portenoy, (1992), supra note 1.CrossRefGoogle Scholar
Weissman, D.E. Haddox, J.D., “Opioid Pseudoaddiction—An Iatrogenic Syndrome,” Pain, 36 (1989): 363-66.CrossRefGoogle Scholar
Rayport, M., “Experience in the Management of Patients Medically Addicted to Narcotics,” JAMA, 156 (1954): 684-91.Google Scholar
Simpson, D.D. Savage, L.J. Lloyd, M.R., “Follow-Up Evaluation of Treatment of Drug Abuse During 1969 to 1972,” Archives of General Psychiatry, 36 (1979): 772-80; and Vallaint, G.E., “A 20-Year Follow-Up of New York Narcotic Addicts,” Archives of General Psychiatry, 29 (1973): 237–41.CrossRefGoogle Scholar
See Wilder, , supra note 43.Google Scholar
Black, R.G., “The Clinical Syndrome of Chronic Pain,” in Ng, L.K.Y. Bonica, J.J., eds., Pain, Discomfort and Humanitarian Care (New York: Elsevier, 1980): 207-09; Buckley, Sizemore, Charlton, , supra note 19; Finlayson, Maruta, Morse, , supra note 19; Maruta, Swanson, Finlayson, , supra note 19; and Ready, Sarkis, Turner, , supra note 19.Google Scholar
Fishbain, D.A. Rosomoff, H.L. Rosomoff, R.S., “Drug Abuse, Dependence, and Addiction in Chronic Pain Patients,” Clinical Journal of Pain, 8 (1992): 77–85.CrossRefGoogle Scholar
Kaiko, R.F. Foley, K.M. Grabinski, P.Y., “Central Nervous System Excitatory Effects of Meperidine in Cancer Patients,” Annals of Neurology, 13 (1983): 180-85; and Jaffe, J.H., “Misinformation: Euphoria and Addiction,” in Hill, C.S. Fields, W.S., eds., Advances in Pain Research and Therapy (New York: Raven Press, Vol. 11, 1989): 163–74.CrossRefGoogle Scholar
Porter, J. Jick, H., “Addiction Rare in Patients Treated with Narcotics,” N. Engl. J. Med., 302 (1980): 123.Google Scholar
Perry, S. Heidrich, G., “Management of Pain During Debridement: A Survey of U.S. Burn Units,” Pain, 13 (1982): 267-80.CrossRefGoogle Scholar
Medina, J.L. Diamond, S., “Drug Dependency in Patients with Chronic Headache,” Headache, 17 (1977): 12–14.CrossRefGoogle Scholar
Chapman, C.R. Hill, H.F., “Prolonged Morphine Self-Administration and Addiction Liability: Evaluation of Two Theories in a Bone Marrow Transplant Unit,” Cancer, 63 (1989): 1636-44.Google Scholar
Regier, D.A.et al, “The NIMH Epidemiologic Catchment Area Program,” Archives of General Psychiatry, 41 (1984): 934-58.Google Scholar
Graeven, D.B. Folmer, W., “Experimental Heroin Users: An Epidemiologic and Psychosocial Approach,” American Journal of Drug and Alcohol Abuse, 4 (1977): 365-75.CrossRefGoogle Scholar
Robins, L.N. Davis, D.H. Nurco, D.N., “How Permanent Was Vietnam Drug Addiction?,” American Journal of Public Health, 64 (1974): 38–43.CrossRefGoogle Scholar
Grove, W.M.et al, “Heritability of Substance Abuse and Antisocial Behavior: A Study of Monozygotic Twins Reared Apart,” Biology and Psychiatry, 27 (1990): 1293-304.CrossRefGoogle Scholar
Anthenelli, R.M. Schuckit, M.A., “Genetics,” in Lowinson, J.H. Ruiz, P. Millman, R.B., eds., Substance Abuse: A Comprehensive Textbook (Baltimore: Williams & Wilkins, 1992): 39–50.Google Scholar
Newman, R.G., “The Need to Redefine Addiction,” N. Engl. J. Med., 18 (1983): 1096-98.Google Scholar
Coambs, R.B.et al, “The SISAP: A New, Screening Instrument for Identifying Potential Opioid Abusers in the Management of Chronic Nonmalignant Pain Within General Medical Practice,” Pain Research and Management, 1 (1996): 155-62.CrossRefGoogle Scholar
Acute Pain Management Guideline Panel, “Acute Pain Management,” Clinical AHCPR Practice Guideline (Rockville: Agency for Health Care Policy and Research, Pub. No. 92-0032, Feb. 1992).Google Scholar