Opium has been used throughout history due to its therapeutic benefit as a potent analgesic. This benefit has, however, come with a price. Recreational, as well as compulsive use coupled by uncontrollable cravings, can undermine public health, have medical, legal, and societal implications, and continues to confound physicians for centuries.

Our history with opioids has also fueled much debate and tensions, provoking a melee of attitudes and policies. For the past 30 years, physicians have struggled with these issues while attempting to advance the science of opioid pharmacology and relieving pain. At present, we have now began to hone our understanding of the fundamental risks associated with these drugs, particularly as these relate to the genetic, psychosocial, and situational predispositions of our patients toward abuse and addiction. These challenging times that provoke outrage over undertreatment of pain and will become increasingly problematic if we fail to fully understand and manage the risks involved in using opioids to help alleviate pain and suffering.

Does this dilemma mean that we need to identify and nurture a proper balance between expanding access and being proactive in our efforts to limit misuse, abuse, addiction, and diversion? Increasingly, the scientific, clinical, and regulatory communities have collaborated to support to therapeutic use of opioids and address the potential for harm.

Read more. Fine P, Portenoy RK: Opioid analgesia. New York: McGraw Hill, 2004. Download Chapt 1

The intent of this book is to help clinicians make practical sense of the varied and often conflicting issues (pharmacological, clinical, and regulatory) surrounding opioid pharmacotherapy, in order to promote the most healthful outcomes possible for patients in pain. The aim is to improve knowledge and skills related to both the principles of prescribing and the management of risk. In this way, healthcare professionals and those they serve may benefit increasingly from the unique therapeutic potential of this drug class, and fear less the undeniable, yet manageable, potential for harm.