Prescribe opioids for chronic non-cancer pain with care for the sake of patients and the community

Freynhagen and colleagues describe the lack of scientific evidence supporting the safety and effectiveness of long term opioids for chronic non-cancer pain. 1 Nevertheless, opioids are now the most prescribed drug in the US, where oxycodone sales reached $3.1bn (£2.08bn; €2.42bn) in 2010. The "4A's" process 1 may be facilitated by rapid questionnaires such as the three item scale of the brief pain inventory. 4 Freynhagen and colleagues suggest that opioids may be suitable in patients at high risk of complications from non-steroidal anti-inflammatory drugs (NSAIDs).