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Annals of Internal Medicine Tip Sheet
July 18, 2017

Below is information about articles published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Contact Angela Collom, Media Relations Manager, at or 215-351-2653 for full text or author contact information.

1. Opioid tapering may improve outcomes for chronic pain sufferers

For the first time, researchers also studied coffee’s effect on white and nonwhite populations

Abstract and free author video:

Dose reduction may improve pain, function, and quality of life for patients prescribed long-term opioid therapy for chronic pain. Results of a systematic evidence review are published in Annals of Internal Medicine.

Approximately 10 million U.S. adults are prescribed long-term opioid therapy for chronic pain. This dramatic increase in opioid prescribing has been accompanied by increases in opioid overdose. Expert guidelines recommend reducing or discontinuing long-term opioid therapy when risks outweigh the benefits, but evidence on the effects of dose reduction on patient outcomes had not been systematically reviewed.

Researchers at the Veterans Health Administration conducted a systematic review of 67 published studies to determine the effectiveness of strategies to reduce or discontinue long-term opioid therapy prescribed for chronic pain and the effect of dose reduction or discontinuation on important patient outcomes. While the overall quality of the evidence was very low, fair-quality studies showed that opioid dose reduction was associated with improvements for outcomes such as pain, function, and quality of life.

The authors noted that there was inadequate evidence to assess the risks of opioid dose reduction. They recommended that, when possible, opioid tapering should be accompanied by multidisciplinary pain programs that incorporate behavioral interventions, such as cognitive behavioral therapy or mindfulness meditation.

Editorialists from the Centers for Disease Control and Prevention (CDC) caution that decisions to discontinue or reduce long-term opioid therapy should be made together with the patient.

Clinicians have a responsibility to carefully manage opioid therapy and not abandon patients in chronic pain. The CDC offers several resources to help physicians in primary care practice navigate pain management and tapering of opioid therapy.

2. The ‘pharmaceuticalization’ of tobacco threatens public health


The reinvention of the tobacco industry as a pharmaceutical company-like purveyor of “safer” tobacco and smoking cessation products is a threat to public health, suggests a commentary published in Annals of Internal Medicine. The authors warn that this type of opportunistic transition, known as pharmaceuticalization, may fundamentally change how policymakers and the public perceive both the tobacco industry and its products.

Pharmaceuticalization is potentially dangerous because it intertwines two false assumptions: For a substantial number of smokers the habit is too ingrained for them to quit, and most smokers who want to quit require pharmacotherapy to do so. These premises are self-serving, as they may guide policy away from prevention or complete cessation, supporting prolonged use of safer nicotine products.

In addition to policy implications, pharmaceuticalization also poses three important health consequences. First, it dilutes and diminishes the process and trust associated with the approval of real pharmaceuticals. Second, it complicates and lessens the regulatory process, as new tobacco drugs and devices are not subjected to the same scrutiny as prescription drugs. And third, pharmaceuticalization legitimizes the tobacco industry.

Through pharmaceuticalization, big tobacco seeks to rehabilitate its image. By seeming responsive to public health concerns, tobacco companies seem to exonerate themselves from the responsibility of having addicted smokers in the first place.


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