Risks, management, and monitoring of combination opioid, benzodiazepines, and/or alcohol use.


:The concurrent use of opioids, benzodiazepines (BZDs), and/or alcohol poses a formidable challenge for clinicians who manage chronic pain. While the escalating use of opioid analgesics for the treatment of chronic pain and the concomitant rise in opioid-related abuse and misuse are widely recognized trends, the contribution of combination use of BZDs, alcohol, and/or other sedative agents to opioid-related morbidity and mortality is underappreciated, even when these agents are used appropriately. Patients with chronic pain who use opioid analgesics along with BZDs and/or alcohol are at higher risk for fatal/nonfatal overdose and have more aberrant behaviors. Few practice guidelines for BZD treatment are readily available, especially when they are combined clinically with opioid analgesics and other central nervous system-depressant agents. However, coadministration of these agents produces a defined increase in rates of adverse events, overdose, and death, warranting close monitoring and consideration when treating patients with pain. To improve patient outcomes, ongoing screening for aberrant behavior, monitoring of treatment compliance, documentation of medical necessity, and the adjustment of treatment to clinical changes are essential. In this article, we review the prevalence and pharmacologic consequences of BZDs and/or alcohol use among patients with pain on chronic opioid therapy, as well as the importance of urine drug testing, an indispensable tool for therapeutic drug monitoring, which helps to ensure the continued safety of patients. Regardless of risk or known aberrant drug-related behaviors, patients on chronic opioid therapy should periodically undergo urine drug testing to confirm adherence to the treatment plan.


Postgrad Med


Postgraduate medicine


Gudin JA,Mogali S,Jones JD,Comer SD




Has Abstract


2013-07-01 00:00:00












  • Pregnancy in adolescents: helping the patient and her family.

    abstract::Dealing with the complex problem of pregnancy in adolescence may involve working with many people. If the physician approaches the patient with an attitude of acceptance and understanding, the adolescent girl may be helped to make realistic decisions concerning her pregnancy and to adjust in a healthy manner. If she d...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章


    authors: Cooper JC

    更新日期:1978-12-01 00:00:00

  • Common variable immunodeficiency, immune thrombocytopenia, rituximab and splenectomy: important considerations.

    abstract::Common variable immunodeficiency (CVID) is readily considered in patients presenting with recurrent sino-pulmonary infections, however this disease has a broad range of clinical manifestations and diagnosis can be delayed by several years. We present the case of a 44-year-old postpartum female who presented with nause...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章


    authors: Arays R,Goyal S,Jordan KM

    更新日期:2016-08-01 00:00:00

  • Sports injuries. Practical diagnostic and management concerns for primary care physicians.

    abstract::Both recreational and elite athletes often sustain musculoskeletal injuries. Common problems--muscle cramps, burners (or stingers), and ankle and shoulder injuries--can be managed effectively with certain basic techniques. Initial measures are particularly important in facilitating the injured athlete's rapid return t...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章


    authors: Sellers RG

    更新日期:1992-08-03 00:00:00

  • Hip problems in children. Aids to early recognition.

    abstract::Awareness of the age at which various pediatric hip disorders present and familiarity with their characteristics greatly aid in early detection. A properly performed physical examination is still the mainstay of early diagnosis. The earlier a hip disorder is discovered and treated, the less the chance of lasting harm ...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章


    authors: Gross RH

    更新日期:1984-09-15 00:00:00

  • Site-specific techniques of joint injection. Useful additions to your treatment repertoire.

    abstract::Joint and soft-tissue aspiration and injection procedures are relatively easy to master once the physician has acquired an understanding of the techniques and subtleties of performing these procedures at certain sites. These techniques can be used to diagnose and treat many painful joint and soft-tissue conditions and...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章


    authors: Rifat SF,Moeller JL

    更新日期:2001-03-01 00:00:00

  • Malnutrition, inflammation, and lipids in a cohort of dialysis patients.

    abstract:BACKGROUND:This study aimed to determine if there is an association between lipid levels, serum albumin, and C-reactive protein (CRP) levels in patients on dialysis. METHODS:Lipid profiles, albumin, and CRP levels were collected after a 12-hour fast from patients with end-stage renal disease (N = 105) who were on chro...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章


    authors: Bowden RG,Wilson RL

    更新日期:2010-05-01 00:00:00

  • Drug-induced illness in the elderly.

    abstract::The elderly are predisposed to adverse drug reactions because of age-related physiologic changes, interaction of one drug with another, and interaction between a drug and a coexisting medical condition. Recognition of such adverse reactions is essential, because many are reversible and many are even preventable. Asses...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审


    authors: Harper CM,Newton PA,Walsh JR

    更新日期:1989-08-01 00:00:00

  • Accuracy and clinical utility of a point-of-care HbA1c testing device.

    abstract:BACKGROUND:Point-of-care testing (POCT) is widely used to measure blood glucose levels in people with diabetes, although its use in measuring glycated hemoglobin (HbA1c) levels is less common, perhaps due to perceived performance issues and access to the technology. METHODS:Forty blood samples were analyzed in duplica...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章


    authors: Knaebel J,Irvin BR,Xie CZ

    更新日期:2013-05-01 00:00:00

  • Genetic causes and workup of male and female infertility. 3. Details of the clinical evaluation.

    abstract::In the evaluation of male and female infertility the history, family history, physical examination, and endocrine and gonadal functional evaluations are the most informative measures. The cause of the infertility is never found in some 17.5% of couples and in almost one fourth of males. In over one third of cases male...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章


    authors: Opitz JM,Shapiro SS,Uehling DT

    更新日期:1979-07-01 00:00:00

  • Cardiovascular risk factors.

    abstract::Preview New information emerges almost weekly about the relative importance of one factor or another in the development of coronary artery disease. Yet controversies continue over which factor deserves the most emphasis. Dr Elliott presents a broad and, at times, humorous look at research into cardiovascular risk fact...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章


    authors: Elliott WJ

    更新日期:1994-09-01 00:00:00

  • Refractory left ventricular failure: use of two-dimensional echocardiography in identification of thrombi.

    abstract::A 65-year-old woman was hospitalized several times after having an acute anteroseptal transmural infarction. Her course was complicated by recurrent ventricular tachycardia and severe left ventricular failure. Chest x-ray films showed pulmonary congestion and mild right pleural effusion. Two-dimensional echocardiograp...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章


    authors: Cheng TC

    更新日期:1982-10-01 00:00:00

  • Advantages of extended-release metformin in patients with type 2 diabetes mellitus.

    abstract::Metformin is a first-line pharmacological treatment for patients with type 2 diabetes mellitus because of its favorable overall profile, including its glucose-lowering ability, weight-neutral effects, and low risk of hypoglycemia; however, gastrointestinal (GI) intolerance may limit use in some patients. Extended-rele...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审


    authors: Jabbour S,Ziring B

    更新日期:2011-01-01 00:00:00

  • Hepatitis C virus. What recent studies can tell us.

    abstract::Hepatitis C virus (HCV) is responsible for most cases of non-A non-B hepatitis and is primarily spread by a parenteral route, although familial, sexual, and maternal transmission may occur rarely. Second-generation assays and the polymerase chain reaction facilitate detection of HCV infection. The association between ...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审


    authors: Dana F,Becherer PR,Bacon BR

    更新日期:1994-05-01 00:00:00

  • Exercise-induced asthma.

    abstract::Exercise-induced asthma can appear as one of many forms of airway hyperreactivity or as a unique clinical entity. Simple spirometry confirms the suspected clinical diagnosis in most instances, although more sensitive measurements of airway obstruction may be required. In general, the asthmatic need not restrict physic...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章


    authors: Gerhard H,Schachter EN

    更新日期:1980-03-01 00:00:00

  • Chronic hepatitis B. Hope for decreasing its impact.

    abstract::Although chronic hepatitis B is a relatively common disease that may have a serious outcome, the outlook is by no means uniformly poor. Alpha interferon therapy may be helpful in up to one third of patients who have hepatitis B e antigen in serum and elevated serum aminotransferase levels. New drugs that may have even...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审


    authors: Di Bisceglie AM

    更新日期:1995-07-01 00:00:00

  • Proteinuria. How much evaluation is appropriate?

    abstract::Primary care physicians play an important role in the outpatient evaluation of proteinuria, a common finding in everyday medical practice. Therefore, it is important to recognize which symptoms and signs signal the need for further evaluation. A simple urine dipstick test usually is the first step, but factors leading...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审


    authors: Ali H

    更新日期:1997-04-01 00:00:00

  • Helicobacter pylori and peptic ulcer disease. Bridging the gap between knowledge and treatment.

    abstract::Eradication of H pylori and cure of peptic ulcer disease are possible if effective regimens are used correctly. Treatment markedly improves clinical outcomes and significantly decreases cost of care. As primary care physicians take a larger role in management of these infections, they need to understand the importance...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审


    authors: Laine L,Fendrick AM

    更新日期:1998-03-01 00:00:00

  • What private-practice doctors can do to contain costs. Steps you can take to preserve a free market.

    abstract::Not all of the costs of private practice, particularly those related to government regulation, are within your control. However, there are steps, both large and small, that you can take to get fees under control and to eliminate or reduce expenditures. Dr Orient suggests a number of these. ...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章


    authors: Orient JM

    更新日期:1994-02-15 00:00:00

  • Angiotensin receptor blocker and dihydropyridine calcium channel blocker combinations: an emerging strategy in hypertension therapy.

    abstract::Hypertension is a leading contributor to the burden of cardiovascular disease. The importance of lowering blood pressure (BP) to reduce the risk of cardiovascular events has been demonstrated in numerous clinical trials. Most patients require combination antihypertensive therapy utilizing agents from complementary dru...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审


    authors: Oparil S,Weber M

    更新日期:2009-03-01 00:00:00

  • Calcium channel antagonists.

    abstract::Preview The success of calcium channel antagonists in controlling hypertension, angina pectoris, and arrhythmias is well known. In recent years, second-generation agents have been introduced that are also effective against migraine headaches and Raynaud's phenomenon and appear to improve atherosclerosis and congestive...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章


    authors: Salerno SM,Zugibe FT Jr

    更新日期:1994-01-01 00:00:00

  • Assessment of the role of serum ischemia-modified albumin in obstructive sleep apnea in comparison with interleukin-6.

    abstract:OBJECTIVES:There is limited and contradictory information regarding the role of serum ischemia-modified albumin (IMA) in obstructive sleep apnea (OSA). In this study we examine the effects of OSA and obesity on IMA and interleukin-6 (IL-6), and detect whether IMA and IL-6 may be potential biomarkers in OSA. METHODS:Fi...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章


    authors: Dogan D,Ocal N,Aydogan M,Tasci C,Arslan Y,Tapan S,Yetkin S,Bilgic H

    更新日期:2016-08-01 00:00:00

  • Hypercalcemia.

    abstract::Preview An elevated serum calcium level requires thorough investigation. Is hyperparathyroidism at the root of the abnormality? Malignant disease? Vitamin toxicity? In this article, Dr Kaye discusses clinical evaluation of hypercalcemia and outlines pharmacologic therapy, surgical intervention, and other treatment opt...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章


    authors: Kaye TB

    更新日期:1995-01-01 00:00:00

  • Primary sclerosing cholangitis and primary biliary cirrhosis. How effective is medical therapy?

    abstract::Although a great deal of investigation has led to some novel approaches in treating primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC), no method has been proven to definitively alter the long-term outcome of either disease. In addition, many of the medical regimens reviewed in this article have ...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审


    authors: Fennerty MB

    更新日期:1993-11-01 00:00:00

  • Using anticoagulants safely. Guidelines for therapeutic and prophylactic regimens.

    abstract::Heparin and warfarin sodium (Coumadin, Panwarfin, Sofarin) are used most often to treat acute and recurrent venous thromboembolic disease, arterial disease, valvular heart disease, and atrial fibrillation. These agents along with dextran, pneumatic compression devices, and gradient stockings are also used to prevent d...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章


    authors: Dhami MS,Bona RD

    更新日期:1991-07-01 00:00:00

  • Adenocarcinoma of the prostate. Stage-by-stage treatment alternatives.

    abstract::The best treatment for adenocarcinoma of the prostate depends on the patient's age, general medical condition, life expectancy, and willingness to accept such side effects as impotence. Radical prostatectomy or full-dose radiation therapy are usually curative when cancer is confined to the gland. The technique of pros...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审


    authors: Soloway MS

    更新日期:1988-11-15 00:00:00

  • Drug-induced jaundice. An uncommon but puzzling reaction.

    abstract::Drug-induced jaundice is relatively uncommon but can be a diagnostic puzzle. Because so many pharmaceutical classes and individual agents can produce jaundice, a thorough history of medications taken should be obtained from a patient presenting with jaundice. Jaundice usually resolves when the offending agent is disco...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审


    authors: Garabedian-Ruffalo SM,Ruffalo RL

    更新日期:1988-10-01 00:00:00

  • Community-acquired pneumonia: An overview.

    abstract::Community-acquired pneumonia is still a significant cause of morbidity and mortality and is often misdiagnosed and inappropriately treated. Although it can be caused by a wide variety of micro-organisms, the pneumococcus, atypicals, such as Mycoplasma pneumoniae and Chlamydophila pneumoniae, Staphylococcus aureus and ...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审


    authors: Mandell LA

    更新日期:2015-08-01 00:00:00

  • Cardioembolic stroke. Primary and secondary prevention.

    abstract::Modern prospective trials have recently shown that warfarin prescribed to produce less anticoagulant effect than was customary in the past reduces cardioembolic stroke by up to 80% in patients with nonvalvular atrial fibrillation. These results represent a major advance in stroke prevention. The effectiveness of antit...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审


    authors: Anderson DC

    更新日期:1991-12-01 00:00:00

  • Diabetic diarrhea. An underdiagnosed complication?

    abstract::Diarrhea is a common gastrointestinal problem in diabetes, and its prevalence has been underestimated. The cause of diabetic diarrhea is unknown, but it is probably related to gastrointestinal motility disturbances secondary to diabetic autonomic neuropathy. Other causes (especially primary malabsorption syndromes and...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章


    authors: Beebe DK,Walley E

    更新日期:1992-06-01 00:00:00

  • Diagnostic performance of CTLA-4, carcinoembryonic antigen and CYFRA 21-1 for malignant pleural effusion.

    abstract:OBJECTIVES:The diagnosis of malignant pleural effusion (MPE) remains a clinical challenge. As a negative regulator of T-cell activation, cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) has been associated with many malignant diseases. However, there is limited data about the relationship between CTLA-4 and MPE. Th...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章


    authors: Chen M,Xie S,Wan C,Zeng N,Wu Y,Qin J,Shen Y,Wen F

    更新日期:2017-08-01 00:00:00