PMID- 33159241
OWN - NLM
STAT- MEDLINE
DCOM- 20210514
LR  - 20211203
IS  - 1525-1497 (Electronic)
IS  - 0884-8734 (Print)
IS  - 0884-8734 (Linking)
VI  - 35
IP  - Suppl 3
DP  - 2020 Dec
TI  - Complex Persistent Opioid Dependence with Long-term Opioids: a Gray Area That 
      Needs Definition, Better Understanding, Treatment Guidance, and Policy Changes.
PG  - 964-971
LID - 10.1007/s11606-020-06251-w [doi]
AB  - The multitude of treatments available for tens of millions of US adults with 
      moderate/severe chronic pain have limited efficacy. Long-term opioid therapy 
      (LTOT) is a widely available option for controlling pain among patients with 
      chronic pain refractory to other treatments. The recent recognition of LTOT 
      inefficacy and complications has led to more frequent opioid tapering, which in 
      turn has revealed its own set of complications. The occurrence of the same set of 
      symptoms-worsening pain, declining function, and clinical instability-in 
      contrasting contexts of LTOT ineffectiveness and opioid tapering has led to 
      increasing recognition of the utility of complex persistent opioid dependence 
      (CPOD), a clinically distinct but biologically similar state compared with opioid 
      use disorder as an explanatory diagnosis/heuristic. Recent guidelines for LTOT 
      tapering have incorporated buprenorphine treatment based on CPOD concepts as a 
      recommended treatment for problems due to opioid tapering with limited supportive 
      evidence. The increasing utilization of buprenorphine for both LTOT 
      ineffectiveness and opioid tapering problems raises the urgent need for a review 
      of the clinical definition, mechanisms, and treatment of CPOD and pertinent 
      policies. In this manuscript, we discuss various issues related to CPOD that 
      requires further clarification through research and policy development.
FAU - Manhapra, Ajay
AU  - Manhapra A
AUID- ORCID: 0000-0001-9208-1490
AD  - Integrative Pain Recovery Service, Hampton VA Medical Center, Hampton, VA, USA. 
      ajay.manhapra@yale.edu.
AD  - VA New England Mental Illness Research and Education Center, West Haven, CT, USA. 
      ajay.manhapra@yale.edu.
AD  - Yale School of Medicine, New Haven, CT, USA. ajay.manhapra@yale.edu.
AD  - Eastern Virginia Medical School, Norfolk, VA, USA. ajay.manhapra@yale.edu.
FAU - Sullivan, Mark D
AU  - Sullivan MD
AD  - University of Washington, Seattle, WA, USA.
FAU - Ballantyne, Jane C
AU  - Ballantyne JC
AD  - University of Washington, Seattle, WA, USA.
FAU - MacLean, R Ross
AU  - MacLean RR
AD  - VA New England Mental Illness Research and Education Center, West Haven, CT, USA.
AD  - Yale School of Medicine, New Haven, CT, USA.
FAU - Becker, William C
AU  - Becker WC
AD  - Yale School of Medicine, New Haven, CT, USA.
LA  - eng
GR  - UL1 TR001863/TR/NCATS NIH HHS/United States
PT  - Editorial
PT  - Review
DEP - 20201106
PL  - United States
TA  - J Gen Intern Med
JT  - Journal of general internal medicine
JID - 8605834
RN  - 0 (Analgesics, Opioid)
SB  - IM
MH  - Adult
MH  - Analgesics, Opioid/adverse effects
MH  - *Chronic Pain/drug therapy
MH  - Humans
MH  - *Opioid-Related Disorders/diagnosis/drug therapy/epidemiology
MH  - Pain Management
MH  - Policy
PMC - PMC7728942
COIS- Ajay Manhapra, Mark D. Sullivan, R. Ross McLean, and William C. Becker have no 
      conflict of interest or other disclosures to make. Jane C. Ballantyne was a paid 
      consultant in opioid litigation.
EDAT- 2020/11/08 06:00
MHDA- 2021/05/15 06:00
PMCR- 2021/12/01
CRDT- 2020/11/07 05:34
PHST- 2020/02/07 00:00 [received]
PHST- 2020/09/17 00:00 [accepted]
PHST- 2020/11/08 06:00 [pubmed]
PHST- 2021/05/15 06:00 [medline]
PHST- 2020/11/07 05:34 [entrez]
PHST- 2021/12/01 00:00 [pmc-release]
AID - 10.1007/s11606-020-06251-w [pii]
AID - 6251 [pii]
AID - 10.1007/s11606-020-06251-w [doi]
PST - ppublish
SO  - J Gen Intern Med. 2020 Dec;35(Suppl 3):964-971. doi: 10.1007/s11606-020-06251-w. 
      Epub 2020 Nov 6.