Opioid Dependence A Clinical and Epidemiologic Approach
This unique and timely title offers a comprehensive assessment of the previously underappreciated risks and potentially overstated benefits of chronic opioid therapy. It does so by approaching the rampant problem of opioid abuse and addiction – curr
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Opioid Dependence
Heath B. McAnally
Opioid Dependence A Clinical and Epidemiologic Approach
Heath B. McAnally, MD, MSPH Medical Director Northern Anesthesia & Pain Medicine, LLC Eagle River, AK, USA Clinical Instructor University of Washington School of Medicine WWAMI Program Anchorage, AK, USA
ISBN 978-3-319-47496-0 ISBN 978-3-319-47497-7 (eBook) DOI 10.1007/978-3-319-47497-7 Library of Congress Control Number: 2017948662 © Springer International Publishing AG 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Preface
The physician’s oath begins with a commitment to risk reduction—primum non nocere. The physician’s responsibility also includes the fundamental duty to relieve suffering whenever possible. Opioids are a powerful and dangerous tool in the therapeutic armamentarium. Much like the homesteader’s chainsaw or the miner’s dynamite in the Last Frontier where I reside, opioids can accomplish much in the short term, although untrained and indiscriminate use invites disaster. As with most decisions in medicine, opioid therapy involves ongoing risk-benefit ratio analysis. At the beginning of the twenty-first century, we are in a position to better evaluate previously underappreciated risks and potentially overstated benefits (of chronic opioid therapy). At an individual level, we are seeing prevalent recalcitrant (and likely increased) chronic pain and depression and dysfunction associated with chronic opioid use. We are becoming aware of immunosuppressive and endocrinopathic effects of this drug class that have not yet made it into standard pharmacology textbooks. We are being told that more people die today in America
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