Below is information about articles being published in the September 17 issue of Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.
In a new policy paper being published in Annals of Internal Medicine, the American College of Physicians (ACP) recommends clinical and administrative changes that will make it harder for prescription drugs, such as those prescribed for pain, sleep disorders, and weight loss, to be abused or diverted for sale on the street. ACP’s Health and Public Policy Committee developed the position paper to provide guidance to prescribers and policymakers faced with the challenge of deterring prescription drug abuse while maintaining patient access to appropriate treatment. A recent analysis of preliminary data from the Centers for Disease Control and Prevention (CDC) suggests that prescription drug abuse may now be the leading cause of accidental death in the United States. A 2010 survey funded by the National Institute on Drug Abuse (NIDA) found that 16 million Americans age 12 and older had taken a prescription pain reliever, tranquilizer, stimulant, or sedative for nonmedical purposes at least once in the previous year. Among the 10 recommendations outlined in the policy paper, ACP strongly advocates for physician, patient, and public education on the harms of medical and nonmedical use of prescription drugs. For the treatment of pain, ACP recommends that physicians consider the full array of treatments available before prescribing opioids. While maximum dosage and duration of therapy limitations may not be appropriate for all patients, ACP recommends the establishment of evidence-based, nonbinding guidelines to inform treatment. ACP also supports the establishment of a national Prescription Drug Monitoring Program (PDMP) so that prescribers and dispensers may check PDMPs in their own and neighboring states before writing and filling prescriptions for substances with high abuse potential. A comprehensive summary of the policy paper, including all 10 recommendations, can be found at http://www.annals.org/article.aspx?doi=10.7326/M13-2209.
Guidelines from the Kidney Disease: Developing Global Guidelines (KDIGO) organization call for wider statin use among patients with chronic kidney disease (CKD). KDIGO updated its clinical practice guidelines for lipid management in patients with CKD earlier in 2013. A synopsis of these guidelines being published in Annals of Internal Medicine focuses on eight specific recommendations relating to pharmacological cholesterol-lowering among adult patients with CKD. Patients recommended for statin use include adults aged 50 or older with eGFR < 60 ml/min/1.73m2 but not treated with dialysis or kidney transplantation. However, patients already taking a statin at the time of dialysis may continue to do so. Statin use is also recommended for kidney transplant recipients, as their risk for coronary events is markedly elevated. Younger adults (18 – 49 years) with eGFR < 60 ml/min/1.73m2 but not treated with dialysis or kidney transplantation should be treated with statins if they are known to have coronary disease, diabetes, prior ischemic stroke, or an estimated 10-year incidence of coronary death or non-fatal myocardial infarction of more than 10 percent. Evidence suggests that LDL-C is not an adequate assessment of cardiovascular risk in people with CKD. Adults with newly identified CKD should be evaluated with a lipid profile, but follow-up measurement is not required. The complete synopsis is available at http://www.annals.org/article.aspx?doi=10.7326/M13-2453.