Addiction and Pain

Schnoll, Sidney H.; Weaver, Michael F.

doi:10.1111/j.1521-0391.2003.tb00554.x

Cited by 26 publications

(16 citation statements)

References 21 publications

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“…The clinical conditions of pain and opioid dependence are not unrelated phenomena (30)(31)(32). Forty-one years ago, Martin and Inglis (33) observed that opioid-addicted patients abuse opioids to treat "an abnormally low tolerance for painful stimuli."…”

Section: Pain and Opioid Dependencementioning

confidence: 99%

Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy

2006

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More patients with opioid addiction are receiving opioid agonist therapy (OAT) with methadone and buprenorphine. As a result, physicians will more frequently encounter patients receiving OAT who develop acutely painful conditions, requiring effective treatment strategies. Undertreatment of acute pain is suboptimal medical treatment, and patients receiving long-term OAT are at particular risk. This paper acknowledges the complex interplay among addictive disease, OAT, and acute pain management and describes 4 common misconceptions resulting in suboptimal treatment of acute pain. Clinical recommendations for providing analgesia for patients with acute pain who are receiving OAT are presented. Although challenging, acute pain in patients receiving this type of therapy can effectively be managed.

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Section: Pain and Opioid Dependencementioning

confidence: 99%

Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy

2006

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“…Potential reasons why we did not find a relationship between past and current substance use disorder in our primary care pain sample include 1) selection issues (i.e., patients with a lifetime problem were not started on opioids and therefore not eligible for our study); 2) sample size issues (only 31 patients met current opioid dependence criteria); and 3) varying criteria used in other chronic pain studies to determine a past history of substance abuse. Many studies reported in the literature rely on medical record documentation, positive toxicology testing, or self-reported use [2,5,30,31]. In our study, patients needed to have participated in alcohol or drug treatment to be considered to have a lifetime history of a substance abuse disorder.…”

Section: Discussionmentioning

confidence: 99%

“…Tel: 608-263-9953; Fax: 313-577-7636; E-mail: mfleming@fammed.wisc.edu. treatments for chronic pain [2][3][4]. However, the presence of aberrant drug behaviors and concerns related to addiction and diversion often deter physicians from prescribing opioids [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Reported Lifetime Aberrant Drug-Taking Behaviors Are Predictive of Current Substance Use and Mental Health Problems in Primary Care Patients

Fleming¹,

Davis²,

Passik³

2008

Pain Med

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Background: The aim of this report is to determine the frequency of aberrant drug behaviors and their relationship substance abuse disorders in a large primary sample of patients receiving opioids for chronic pain. Methods: The data utilized for this report was obtained from 904 chronic pain patients receiving opioid therapy from their primary care physician. A questionnaire was developed based on 12 aberrant drug behaviors reported in the clinical literature. The diagnosis of a current substance use disorder was determined using DSM-IV criteria. Results: The average duration of chronic pain in the sample was 16 years, and for opioid therapy 6.4 years. 80.5% of the sample reported one or more lifetime aberrant drug behaviors. The most frequent behaviors reported included early refills (41.7%), increase dose without physician consent (35.7%) and felt intoxicated from opioids (32.2%). Only 1.1% of subjects with 1-3 aberrant behaviors (n=464, 51.2%) met DSM-IV criteria for current opioid dependence compared to 9.9% of patients with 4 or more behaviors (n=264, 29.3%). Persons with a positive urine toxicology tests for cocaine were 14 times more likely to report 4 or more behaviors than no behaviors (14.1% v.s.1.1%). A logistic model found that subjects who reported four or more aberrant behaviors were more likely to have a current substance use disorder (OR 10.14; 3.72, 27.64), a positive test for cocaine (OR 3.01; 1.74, 15.4), an ASI psychiatric composite score >0.5 (OR 2.38; 1.65, 3.44), male gender (OR 2.08: 1.48, 2.92) and older age (OR 0.69; 0.59, 0.81) compared to subjects with three or fewer behaviors. Pain levels, employment status and morphine equivalent dose do not enter the model. Conclusions: Patients who report 4 or more aberrant drug behaviors are associated with a current substance use disorder and illicit drug use, whereas subjects with up to 3 aberrant behaviors have a very low probability of a current substance abuse disorder. Four behaviors - over sedated oneself, felt intoxicated, early refills, increase dose on own – appear useful as a screening questions to predict patients at greatest risk for a current substance use disorders.

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“…A medication agreement (or contract) reinforces the patient's responsibility as a prerequisite for receiving controlled substance prescriptions, and reassures the patient that honoring the agreement will result in continued provision of adequate amounts of pain medication (Schnoll & Weaver, 2003). Basic monitoring efforts involve obtaining pharmacy records on a routine basis or sending regular inquiries to a state prescription monitoring program, keeping track of time elapsed between clinic visits, counting medication units prescribed, and random urine collection for testing (Weaver & Schnoll, 2002).…”

Section: Discharge Planningmentioning

confidence: 99%

Identification and Management of Prescription Opioid Abuse in Hospitalized Patients

Jewell

Tomlinson

Weaver

2011

Journal of Addictions Nursing

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Prescribing of opioids for acute and chronic pain has increased; so has the incidence of abuse of these medications. Patients in the hospital may have hyperalgesia, tolerance, and dependence on opioids which can complicate their overall treatment. Some patients have opioid addiction from prescription opioids as well as heroin with aberrant medicine taking behaviors. Managing these patients takes special knowledge and skills from the whole team. It is important to identify patient concerns and barriers to treatment and work as a team to treat the pain with pharmacological, nonpharmacological, and behavioral techniques to help keep the patient safe and comfortable during their hospitalization. A nonjudgmental attitude and problem-solving approach are necessary for medical (pain) and psychosocial issues. Recommendations for safe prescribing of opioids to the addicted patient at discharge are included.

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Addiction and Pain

Cited by 26 publications

References 21 publications

Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy

Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy

Reported Lifetime Aberrant Drug-Taking Behaviors Are Predictive of Current Substance Use and Mental Health Problems in Primary Care Patients

Identification and Management of Prescription Opioid Abuse in Hospitalized Patients

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