Misuse of and Dependence on Opioids: Study of Chronic Pain Patients

Overview

Journal Can Fam Physician

Specialties General Medicine
Public Health

Date 2007 Feb 7

PMID 17279218

Citations 23

Authors

Meldon Kahan

Anita Srivastava

Lynn Wilson

Douglas Gourlay

Deana Midmer

Affiliations

Soon will be listed here.

Abstract

Objective: To review the evidence on identifying and managing misuse of and dependence on opioids among primary care patients with chronic pain.

Quality Of Evidence: MEDLINE was searched using such terms as "opioid misuse" and "addiction." The few studies on the prevalence of opioid dependence in primary care populations were based on retrospective chart reviews (level II evidence). Most recommendations regarding identification and management of opioid misuse in primary care are based on expert opinion (level III evidence).

Main Message: Physicians should ask all patients receiving opioid therapy about current, past, and family history of addiction. Physicians should take "universal precautions" that include careful prescribing and ongoing vigilance for signs of misuse. Patients suspected of opioid misuse can be treated with a time-limited trial of structured opioid therapy if they are not acquiring opioids from other sources. The trial should consist of daily to weekly dispensing, regular urine testing, and tapering of doses of opioids. If the trial fails or is not indicated, patients should be referred for methadone or buprenorphine treatment.

Conclusion: Misuse of and dependence on opioids can be identified and managed successfully in primary care.

Citing Articles

Role of ERK in gender difference of fibromyalgia pain.

Chang J, Chen K, Tsai S, Zeng Y, Li C, Chen K Mol Pain. 2024; 20:17448069241261940.

PMID: 38818809 PMC: 11168046. DOI: 10.1177/17448069241261940.

Unveiling Morphine: A Rapid and Selective Fluorescence Sensor for Forensic and Medical Analysis.

Boroujerdi R, Butt A, Paul R, Majumder S Sensors (Basel). 2024; 24(6).

PMID: 38543983 PMC: 10974434. DOI: 10.3390/s24061722.

The use of islamic spiritual care practices among critically ill adult patients: A systematic review.

Rababa M, Al-Sabbah S Heliyon. 2023; 9(3):e13862.

PMID: 36915488 PMC: 10006532. DOI: 10.1016/j.heliyon.2023.e13862.

Indirect Effects of Negative Mood on Opioid Misuse and Dependence via Anxiety Sensitivity Subfacets: Evidence from Adults Reporting Chronic Pain.

Smit T, Mayorga N, Rogers A, Woods S, Heggeness L, Kauffman B Subst Use Misuse. 2023; 58(4):570-577.

PMID: 36762460 PMC: 10088564. DOI: 10.1080/10826084.2023.2177969.

French-Canadian Translation and Cultural Adaptation of the Clinical Opiate Withdrawal Scale: The COWS-FC.

Bruneau A, Poirier C, Berube M, Boulanger A, Gelinas C, Guenette L Can J Psychiatry. 2022; 67(9):701-711.

PMID: 35290134 PMC: 9449138. DOI: 10.1177/07067437221087066.

References

Joranson D, Ryan K, Gilson A, Dahl J . Trends in medical use and abuse of opioid analgesics. JAMA. 2001; 283(13):1710-4. DOI: 10.1001/jama.283.13.1710. View

Adams L, Gatchel R, Robinson R, Polatin P, Gajraj N, Deschner M . Development of a self-report screening instrument for assessing potential opioid medication misuse in chronic pain patients. J Pain Symptom Manage. 2004; 27(5):440-59. DOI: 10.1016/j.jpainsymman.2003.10.009. View

Wall R, Rehm J, Fischer B, Brands B, Gliksman L, Stewart J . Social costs of untreated opioid dependence. J Urban Health. 2001; 77(4):688-722. PMC: 3456775. DOI: 10.1007/BF02344032. View

Rome J, Townsend C, Bruce B, Sletten C, Luedtke C, Hodgson J . Chronic noncancer pain rehabilitation with opioid withdrawal: comparison of treatment outcomes based on opioid use status at admission. Mayo Clin Proc. 2004; 79(6):759-68. DOI: 10.4065/79.6.759. View

Passik S, Kirsh K, Whitcomb L, Portenoy R, Katz N, Kleinman L . A new tool to assess and document pain outcomes in chronic pain patients receiving opioid therapy. Clin Ther. 2004; 26(4):552-61. DOI: 10.1016/s0149-2918(04)90057-4. View

Gilson A, Ryan K, Joranson D, Dahl J . A reassessment of trends in the medical use and abuse of opioid analgesics and implications for diversion control: 1997-2002. J Pain Symptom Manage. 2004; 28(2):176-88. DOI: 10.1016/j.jpainsymman.2004.01.003. View

Michna E, Ross E, Hynes W, Nedeljkovic S, Soumekh S, Janfaza D . Predicting aberrant drug behavior in patients treated for chronic pain: importance of abuse history. J Pain Symptom Manage. 2004; 28(3):250-8. DOI: 10.1016/j.jpainsymman.2004.04.007. View

Lamb R, Preston K, Schindler C, Meisch R, Davis F, Katz J . The reinforcing and subjective effects of morphine in post-addicts: a dose-response study. J Pharmacol Exp Ther. 1991; 259(3):1165-73. View

Johnson R, Jaffe J, Fudala P . A controlled trial of buprenorphine treatment for opioid dependence. JAMA. 1992; 267(20):2750-5. View

10.

Fishbain D, Rosomoff H, Rosomoff R . Drug abuse, dependence, and addiction in chronic pain patients. Clin J Pain. 1992; 8(2):77-85. DOI: 10.1097/00002508-199206000-00003. View

11.

Brown R, Rounds L . Conjoint screening questionnaires for alcohol and other drug abuse: criterion validity in a primary care practice. Wis Med J. 1995; 94(3):135-40. View

12.

Krausz M, Degkwitz P, Haasen C, Verthein U . Opioid addiction and suicidality. Crisis. 1996; 17(4):175-81. DOI: 10.1027/0227-5910.17.4.175. View

13.

Bouchez J, Vignau J . The French experience--the pharmacist, general practitioner and patient perspective. Eur Addict Res. 1998; 4 Suppl 1:19-23. DOI: 10.1159/000052037. View

14.

Vignau J, Brunelle E . Differences between general practitioner- and addiction centre-prescribed buprenorphine substitution therapy in France. Preliminary results. Eur Addict Res. 1998; 4 Suppl 1:24-8. DOI: 10.1159/000052038. View

15.

Compton P, Darakjian J, Miotto K . Screening for addiction in patients with chronic pain and "problematic" substance use: evaluation of a pilot assessment tool. J Pain Symptom Manage. 1999; 16(6):355-63. DOI: 10.1016/s0885-3924(98)00110-9. View

16.

Strain E, Bigelow G, Liebson I, Stitzer M . Moderate- vs high-dose methadone in the treatment of opioid dependence: a randomized trial. JAMA. 1999; 281(11):1000-5. DOI: 10.1001/jama.281.11.1000. View

17.

Oyefeso A, Ghodse H, Clancy C, Corkery J, Goldfinch R . Drug abuse-related mortality: a study of teenage addicts over a 20-year period. Soc Psychiatry Psychiatr Epidemiol. 1999; 34(8):437-41. DOI: 10.1007/s001270050166. View

18.

Mahowald M, Singh J, Majeski P . Opioid use by patients in an orthopedics spine clinic. Arthritis Rheum. 2005; 52(1):312-21. DOI: 10.1002/art.20784. View

19.

Chelminski P, Ives T, Felix K, Prakken S, Miller T, Perhac J . A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity. BMC Health Serv Res. 2005; 5(1):3. PMC: 546203. DOI: 10.1186/1472-6963-5-3. View

20.

Gourlay D, Heit H, Almahrezi A . Universal precautions in pain medicine: a rational approach to the treatment of chronic pain. Pain Med. 2005; 6(2):107-12. DOI: 10.1111/j.1526-4637.2005.05031.x. View