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Media type:
E-Article
Title:
Prescription Opioid Abuse in Chronic Pain:
A Review of Opioid Abuse Predictors and
Strategies to Curb Opioid Abuse
Contributor:
Sehgal, Nalini
Published:
American Society of Interventional Pain Physicians, 2012
Published in:
July 2012, 3S;15 (2012) 3S;7, Seite S67-ES92
Language:
English
DOI:
10.36076/ppj.2012/15/es67
ISSN:
2150-1149;
1533-3159
Origination:
Footnote:
Description:
Both chronic pain and prescription opioid abuse are prevalent and continue to exact a heavytoll on patients, physicians, and society. Individuals with chronic pain and co-occurringsubstance use disorders and/or mental health disorders, are at a higher risk for misuse ofprescribed opioids. Opioid abuse and misuse occurs for a variety of reasons, including selfmedication, use for reward, compulsive use because of addiction, and diversion for profit.Treatment approaches that balance treating chronic pain while minimizing risks for opioidabuse, misuse, and diversion are much needed. The use of chronic opioid therapy for chronicnoncancer pain has increased dramatically in the past 2 decades in conjunction with a markedincrease in the abuse of prescribed opioids and accidental opioid overdoses. Consequently,a validated screening instrument that provides an effective and rational method of selectingpatients for opioid therapy, predicting risk, and identifying problems once they arise couldbe of enormous benefit. Such an instrument could potentially curb the risk of iatrogenicaddiction. Although several screening instruments and strategies have been introducedin the past decade, there is no single test or instrument that can reliably and accuratelypredict patients who are not suitable for opioid therapy or identify those who need increasedvigilance or monitoring during therapy.At present, screening for opioid abuse includes assessment of premorbid and comorbidsubstance abuse; assessment of aberrant drug-related behaviors; risk factor stratification; andutilization of opioid assessment screening tools. Multiple opioid assessment screening toolsand instruments have been developed by various authors. In addition, urine drug testing,monitoring of prescribing practices, prescription monitoring programs, opioid treatmentagreements, and utilization of universal precautions are essential. Presently, a combinationof strategies is recommended to stratify risk, identify and understand aberrant drug relatedbehaviors, and tailor treatments accordingly.This manuscript will review the current state of knowledge regarding the growing problemof opioid abuse and misuse; known risk factors; and methods of predicting, assessing,monitoring, and addressing opioid abuse and misuse in patients with chronic noncancer pain.Key words: Opioids, misuse, abuse, chronic pain, prevalence, risk assessment, riskmanagement, drug monitoring, aberrant drug-related behavior