We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Commentary |

Curtailing Diversion and Abuse of Opioid Analgesics Without Jeopardizing Pain Treatment

Nora D. Volkow, MD; Thomas A. McLellan, PhD
JAMA. 2011;305(13):1346-1347. doi:10.1001/jama.2011.369.
Text Size: A A A
Published online


Opioid analgesics are among the most effective medications for pain management (including noncancer pain), but they are also associated with serious and increasing public health problems, such as abuse (ie, use for nonmedical purposes), addiction, and deaths from opioid overdose (excluding heroin). Both immediate and extended opioid release formulations, including methadone, are abused and contribute to overdose. For example, since 2002, the US prevalence of high school seniors reporting past-year nonmedical use of opioids has been 8% to 10% for hydrocodone and 4% to 5% for oxycodone.1 After excluding alcohol and tobacco, the prevalence of hydrocodone abuse is second only to marijuana abuse. Concurrently, there has been a 5-fold increase in drug treatment admissions for pharmaceutical opioids between 1998 and 2008, from 19 941 to 121 091.2 In addition, emergency department visits related to pharmaceutical opioids have increased from 144 644 to 305 885, between 2004 and 2008, and unintentional opioid-related overdose deaths have increased from about 3000 to 12 000 between 1999 and 2007.3 Opioid overdose is now the second leading cause of unintentional death in the United States, second only to motor vehicle crashes,4 which prompted the Centers for Disease Control and Prevention to label pharmaceutical opioid overdose as a national epidemic.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

89 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Related Multimedia

Author Interview

audio player

Articles Related By Topic
PubMed Articles

Care at the Close of Life: Evidence and Experience
Use of Opioid Analgesics for a Pain Crisis in an Inpatient Setting

Care at the Close of Life: Evidence and Experience
Pain Management and Symptomatic Measures