{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T17:23:01Z","timestamp":1777915381726,"version":"3.51.4"},"reference-count":83,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Palliative Medicine"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Despite widespread use of opioid therapy in outpatient palliative medicine, there is limited evidence supporting its efficacy and safety in the long term.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>We sought to improve overdose risk scores, maintain pain reduction, and preserve patient function in a cohort with severe chronic pain as we managed opioid therapy for a duration of four years in an outpatient palliative care clinic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Over four years, we provided ongoing goal-concordant outpatient palliative care, including opioid therapy, using quarterly clinical encounters for a patient cohort with chronic pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting\/Subjects:<\/jats:title>\n                    <jats:p>The project took place in the outpatient palliative medicine clinic of a regional cancer center in Orlando, Florida (United States). The subjects were a cohort group who received palliative care during the time period between July 2018 and October 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements:<\/jats:title>\n                    <jats:p>Key metrics included treatment-related reduction in pain intensity, performance scores, and overall overdose risk scores. Secondary metrics included cohort demographics, average daily opioid use in morphine milligram equivalents and categorization of type of pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In 97 patients, we observed a stable mean treatment-related reduction in pain intensity of 4.9 out of 10 points over four years. The cohort showed a 2-point (out of 100) improvement in performance scores and an 81-point (out of 999) reduction in mean overall overdose risk score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>We present evidence that providing outpatient palliative care longitudinally over four years offered lasting treatment-related reductions in pain intensity, preservation of performance status, and reduction in overall overdose risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/jpm.2023.0251","type":"journal-article","created":{"date-parts":[[2023,8,8]],"date-time":"2023-08-08T16:31:17Z","timestamp":1691512277000},"page":"31-38","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["Effectiveness of Long-Term Opioid Therapy for Chronic Pain in an Outpatient Palliative Medicine Clinic"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3851-9492","authenticated-orcid":false,"given":"Chad D.","family":"Kollas","sequence":"first","affiliation":[{"name":"Supportive and Palliative Care, Orlando Health Cancer Institute, Orlando, Florida, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Ruiz","sequence":"additional","affiliation":[{"name":"University of Central Florida College of Medicine, Orlando, Florida, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Laughlin","sequence":"additional","affiliation":[{"name":"Breast Medical Oncology and Cancer Genetics, Orlando Health Cancer Institute, Orlando, Florida, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,1,5]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/JGP.0b013e3182331732"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1995.03530200027032"},{"key":"e_1_3_4_4_2","unstructured":"Institute of Medicine (US) Committee on Care at the End of Life; Field MJ Cassel CK editors. Approaching Death: Improving Care at the End of Life. National Academies Press: Washington DC USA; 1997. Committee on Care at the End of Life. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK233594\/ [Last accessed: February 20 2023]."},{"issue":"1","key":"e_1_3_4_5_2","first-page":"25","article-title":"Model guidelines for the use of controlled substances for the treatment of pain","volume":"52","author":"The Federation of State Medical Boards of The United States","year":"1999","unstructured":"The Federation of State Medical Boards of The United States, Inc., Model guidelines for the use of controlled substances for the treatment of pain. S D J Med, 1999; 52(1):25\u201327.","journal-title":"S D J Med"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.284.4.423b"},{"key":"e_1_3_4_7_2","unstructured":"American Medical Association. 2022 Overdose Epidemic Report. Available from: https:\/\/www.ama-assn.org\/system\/files\/ama-overdose-epidemic-report.pdf [Last accessed: February 27 2023]."},{"key":"e_1_3_4_8_2","unstructured":"Florida Senate. Senate Bill 2272 (2010). CS\/CS\/SB 2272: Controlled Substances [SPSC]. Available from: https:\/\/www.flsenate.gov\/Session\/Bill\/2010\/2272 [Last accessed: February 20 2023]."},{"key":"e_1_3_4_9_2","unstructured":"State of Florida Department of Medicine. In Re: Petition for Declaratory Statement. Final Order No. DOH-11-2393-DS-MQA October 7 2011. Available from: www.floridahealth.gov\/licensing-and-regulation\/declaratory\/_documents\/medical\/doh-11-2393-ds.pdf [Last accessed: March 7 2023]."},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2017.12.36"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr6501e1"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.1464"},{"key":"e_1_3_4_13_2","unstructured":"Florida State Senate. Florida statutes \u00a7 456.44(1). Regulation of professions and occupations: Health professions and occupations general provisions\u2014controlled substance prescribing. 2018. Available from: https:\/\/www.flsenate.gov\/laws\/statutes\/2018\/456.44 [Last accessed: December 20 2022]."},{"key":"e_1_3_4_14_2","unstructured":"Kollas C. Mandated Queries of the Florida Prescription Drug Monitoring Program: A Three-Month Experience from a Cancer Center-Based Outpatient Palliative Medicine Clinic. Pallimed. November 2019. Available from: https:\/\/www.pallimed.org\/2019\/11\/mandated-queries-of-florida.html [Last accessed: February 20 2023]."},{"key":"e_1_3_4_15_2","unstructured":"Kollas C. Mandated Queries of the Florida Prescription Drug Monitoring Program: Early Experiences from a Cancer Center-based Outpatient Palliative Medicine Clinic. Pallimed. November 2019. Available from: https:\/\/www.pallimed.org\/2018\/09\/mandated-queries-of-florida.html [Last accessed: February 20 2023]."},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.0234"},{"key":"e_1_3_4_17_2","unstructured":"NarxCare. Explain the Overdose Risk Score (Guidance on Page 2). Available from: https:\/\/florida.pmpaware.net\/narx-content\/content\/narxcare2\/explain-overdose-risk-score.pdf [Last accessed: February 20 2023]."},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1904190"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/onco.13898"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.00476"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.33532"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2019.05.001"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-019-05227-9"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m283"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.11013"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pny219"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1370\/afm.2591"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2022.05.001"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMe1004139"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.52.4629"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2010.08.016"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11864-019-0647-0"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(194811)1:4<634::AID-CNCR2820010410>3.0.CO;2-L"},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.1177\/082585979601200102"},{"key":"e_1_3_4_35_2","unstructured":"Huizenga J Breneman B Patel V et al. NARxCHECK\u00ae Score as a Predictor of Unintentional Overdose Death. Appriss: Louisville KY USA; 2016."},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2021.109067"},{"key":"e_1_3_4_37_2","unstructured":"E-FORCSE Florida Prescription Drug Monitoring Program. Explain the Overdose Risk Score (Guidance on Page 2). Available from: https:\/\/florida.pmpaware.net\/narx-content\/content\/narxcare2\/explain-overdose-risk-score.pdf [Last accessed: February 22 2023]."},{"key":"e_1_3_4_38_2","unstructured":"Apriss Health. About NarxCare: For Patients and Their Families. Available from: https:\/\/www.floridahealth.gov\/statistics-and-data\/e-forcse\/narxcare-patient-information-sheet.pdf [Last accessed: May 20 2023]."},{"key":"e_1_3_4_39_2","unstructured":"Nicholson KM Hoffman DE Kollas CD. Overzealous use of the CDC's opioid prescribing guideline is harming pain patients. Stat News. December 6 2018. Available from: https:\/\/www.statnews.com\/2018\/12\/06\/overzealous-use-cdc-opioid-prescribing-guideline\/ [Last accessed: December 21 2022]."},{"key":"e_1_3_4_40_2","unstructured":"Reilly KB. How the CDC's opioid prescribing guidance went astray. American Medical Association (Press Release). April 26 2019. Available from: https:\/\/www.ama-assn.org\/delivering-care\/opioids\/how-cdc-s-opioid-prescribing-guidance-went-astray [Last accessed: December 21 2022]."},{"key":"e_1_3_4_41_2","unstructured":"FDA Drug Safety Communications. FDA identifies harm reported from sudden discontinuation of opioid pain medicines and requires label changes to guide prescribers on gradual individualized tapering. April 9 2019. Available from: https:\/\/www.fda.gov\/media\/122935\/download [Last accessed: December 21 2022]."},{"key":"e_1_3_4_42_2","unstructured":"FDA Drug Safety Podcast. FDA identifies harm reported from sudden discontinuation of opioid pain medicines and requires label changes to guide prescribers on gradual individualized tapering. April 17 2019. Available from: https:\/\/www.fda.gov\/drugs\/fda-drug-safety-podcasts\/fda-identifies-harm-reported-sudden-discontinuation-opioid-pain-medicines-and-requires-label-changes#:~:text=On%20April%209%2C%202019%20FDA %2C%20psychological%20distress%2C%20and%20suicide [Last accessed: December 21 2022]."},{"key":"e_1_3_4_43_2","unstructured":"CDC Media Relations. CDC Advises Against Misapplication of the Guideline for Prescribing Opioids for Chronic Pain. Embargoed Until: Wednesday April 24 2019 5 PM EDT. Available from: https:\/\/www.cdc.gov\/media\/releases\/2019\/s0424-advises-misapplication-guideline-prescribing-opioids.html [Last accessed: December 21 2022]."},{"key":"e_1_3_4_44_2","unstructured":"Benjamin LJ Dampier CD Jacox A et al. Guideline for the Management of Acute and Chronic Pain in Sickle-Cell Disease. American Pain Society: Glenview IL USA; 1999."},{"key":"e_1_3_4_45_2","unstructured":"Benjamin LJ Dampier CD Jacox A et al. Guideline for the Management of Acute Pain in Sickle-Cell Disease Quick Reference Guide for Emergency Department Clinicians. American Pain Society: Glenview IL USA; 2001."},{"key":"e_1_3_4_46_2","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2019.0038"},{"key":"e_1_3_4_47_2","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2021.0028"},{"key":"e_1_3_4_48_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.68.5206"},{"key":"e_1_3_4_49_2","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2020001851"},{"key":"e_1_3_4_50_2","unstructured":"National Consensus Project for Quality Palliative Care. Clinical practice guidelines for quality palliative care 4th ed. National Coalition for Hospice and Palliative Care: Richmond VA USA; 2018. Available from: https:\/\/www.nationalcoalitionhpc.org\/ncp\/ [Last accessed: February 23 2023]."},{"key":"e_1_3_4_51_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr7103a1"},{"key":"e_1_3_4_52_2","unstructured":"Personal communication Orlando Health IRB #1 to Chad Kollas MD. [1906703-1] Examining Trends in NarxCare Scores and the Durability of Pain Response to Long-term Opioid Therapy in an Outpatient Palliative Medicine Clinic based within a Regional Cancer Institute; June 30 2022."},{"key":"e_1_3_4_53_2","unstructured":"Orlando Regional Medical Center. Available from: https:\/\/en.wikipedia.org\/wiki\/Orlando_Regional_Medical_Center [Last accessed: February 27 2023]."},{"key":"e_1_3_4_54_2","unstructured":"Fleming P. Why Orlando's Growth Rate is the Second Fastest of the 30 largest U.S. Cities. Orlando Economic Partnership. January 1 2021. Available from: https:\/\/news.orlando.org\/blog\/orlandos-fast-growth-in-a-category-all-its-own\/#_ftn2 [Last accessed: January 3 2023]."},{"key":"e_1_3_4_55_2","unstructured":"Florida Senate. 2019 Bill Summaries. CS\/CS\/HB 451\u2014Nonopioid Alternatives. Available from: https:\/\/www.flsenate.gov\/Committees\/billsummaries\/2019\/html\/2079 [Last accessed: February 28 2023]."},{"key":"e_1_3_4_56_2","unstructured":"Center to Advance Palliative Care (CAPC). Pain Management. Available from: https:\/\/www.capc.org\/training\/pain-management\/ [Last accessed: March 1 2023]."},{"key":"e_1_3_4_57_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1465-3362.2010.00283.x"},{"key":"e_1_3_4_58_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2015.0335"},{"key":"e_1_3_4_59_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2012.02.023"},{"key":"e_1_3_4_60_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-014-2167-6"},{"key":"e_1_3_4_61_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2019.01.011"},{"key":"e_1_3_4_62_2","doi-asserted-by":"publisher","DOI":"10.1111\/pme.12926"},{"key":"e_1_3_4_63_2","doi-asserted-by":"publisher","DOI":"10.2147\/JPR.S162926"},{"key":"e_1_3_4_64_2","doi-asserted-by":"publisher","DOI":"10.23970\/AHRQEPCCER229"},{"key":"e_1_3_4_65_2","doi-asserted-by":"publisher","DOI":"10.23970\/ahrqepcerta218"},{"key":"e_1_3_4_66_2","doi-asserted-by":"publisher","DOI":"10.2196\/21380"},{"key":"e_1_3_4_67_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15945"},{"key":"e_1_3_4_68_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2021.05.008"},{"key":"e_1_3_4_69_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1004123"},{"key":"e_1_3_4_70_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-056436"},{"key":"e_1_3_4_71_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13011-020-00309-y"},{"key":"e_1_3_4_72_2","doi-asserted-by":"publisher","DOI":"10.1080\/15284336.2019.1627509"},{"key":"e_1_3_4_73_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2021.109236"},{"key":"e_1_3_4_74_2","doi-asserted-by":"publisher","DOI":"10.2217\/pmt-2017-0065"},{"key":"e_1_3_4_75_2","unstructured":"Mukkamala B. Over-the-counter naloxone has the power to save lives\u2014But removing barriers to access is an essential next step. MedPage Today. February 23 2023. Available at https:\/\/www.medpagetoday.com\/opinion\/second-opinions\/103237 [Last accessed: February 23 2023]."},{"key":"e_1_3_4_76_2","unstructured":"Horn DB Vu L Porter BR et al. Responsible Controlled Substance and Opioid Prescribing 2022. In: StatPearls [Internet]. StatPearls Publishing: Treasure Island FL USA; 2022."},{"key":"e_1_3_4_77_2","unstructured":"Thomson RM Chirag RJ Lally KM. Essentials 1: Medical Care of People with Serious Illness. Available from: https:\/\/learn.aahpm.org\/content\/essentials-1-book-medical-care-patients-serious-illness [Last accessed: February 21 2023]."},{"key":"e_1_3_4_78_2","unstructured":"Widera E. Chronic Cancer versus Non-Cancer Pain: A Distinction without a Difference? GeriPal. March 3 2016. Available from: https:\/\/geripal.org\/chronic-cancer-versus-non-cancer-pain\/ [Last accessed: March 6 2023]."},{"key":"e_1_3_4_79_2","doi-asserted-by":"publisher","DOI":"10.2147\/JPR.S99629"},{"key":"e_1_3_4_80_2","unstructured":"David C Libermann AJ. The Network for Public Health Law. Laws Limiting the Prescribing or Dispensing Opioids. December 31 2019. Available from: https:\/\/www.networkforphl.org\/wp-content\/uploads\/2021\/05\/50-State-Survey-Laws-Limiting-the-Prescribing-or-Dispensing-of-Opioidspf-CSD_FINAL.pdf [Last accessed: January 11 2023]."},{"key":"e_1_3_4_81_2","unstructured":"Inappropriate Use of CDC Guidelines for Prescribing Opioids D-120.932. AMA Policy Compendium. Available from: https:\/\/policysearch.ama-assn.org\/policyfinder\/detail\/opioid%20dosing?uri=%2FAMADoc%2Fdirectives.xml-D-120.932.xml [Last accessed: January 6 2023]."},{"key":"e_1_3_4_82_2","unstructured":"AMA Substance Use and Pain Care Task Force. 10:30 to 11:15 AM: Discussion with ONDCP Director Rahul Gupta MD. Agenda for Meeting of December 7 2022."},{"key":"e_1_3_4_83_2","unstructured":"Federation of State Medical Boards. Opioids and Pain Management. Available from: https:\/\/www.fsmb.org\/opioids\/ [Last accessed: January 16 2023]."},{"key":"e_1_3_4_84_2","unstructured":"American Academy of Hospice and Palliative Medicine. Maintaining Legitimate Access to Prescription Medications. Available from: https:\/\/aahpm.org\/issues\/prescriptions [Last accessed January 13 2023]."}],"container-title":["Journal of Palliative Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/jpm.2023.0251","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/jpm.2023.0251","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/jpm.2023.0251","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T17:18:43Z","timestamp":1777655923000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/jpm.2023.0251"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":83,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1089\/jpm.2023.0251"],"URL":"https:\/\/doi.org\/10.1089\/jpm.2023.0251","relation":{},"ISSN":["1096-6218","1557-7740"],"issn-type":[{"value":"1096-6218","type":"print"},{"value":"1557-7740","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1]]}}}