Primary care physicians, emergency physicians, oncologists, orthopedic surgeons, and other physicians are at the frontline of providing pain therapy for patients with acute illness and rescue treatments for patients with exacerbations of chronic pain. Increasingly, this role is compromised by concerns about the prevalence of opioid abuse and diversion of prescribed medications from the intended patient to others who abuse opioids. Individual use of prescription opioids increased 402% from 1997 to 2007.1 This increase in opioid prescribing parallels substantial increases in opioid addiction, fatal overdoses, and diversion of these drugs for recreational or nonmedical use.2 In 2007, opioid overdose was the second leading cause of unintentional deaths in the United States after motor vehicle collisions. Fatalities associated with prescription drug use are more numerous than deaths from cocaine and heroin combined.3
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