Do you believe that long acting opioids should be used routinely when patients are taking round the clock meds? A recently published study http://bit.ly/18y6RXL concluded that long acting but not short acting opioids were associated with hypogonadism in men. Boxed warnings on long acting opioids now read that if short acting opioids are effective they should continue to be used rather than switching to long acting.
Without large studies to prove a concept and insure the absence of unwanted effects, the standard of care has been that more expensive long acting opioids were preferable because they were assumed to be less likely to lead to abuse and addiction. I experienced this opinion as a mandate when a mail- in pharmacy my patient was using, said that if I didn’t write for long acting opioids they would no longer dispense meds to him. Opinion based guidelines, rather than evidence based guidelines, unfortunately is driving much of the practice of pain medicine.
Filed under: opioids • pain management
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