Prescription opioid abuse, pain and addiction: Clinical issues and implications

Abstract

Issues Prescription opioid misuse in the USA has increased over threefold since 1990 to epidemic proportions, with substantial increases in prescription opioid use also reported in other countries, such as Australia and New Zealand. The broad availability of prescription pain medications, coupled with public misconceptions about their safety and addictive potential, have contributed to the recent surge in non-medical use of prescription opioids and corresponding increases in treatment admissions for problems related to opioid misuse. Given competing pressures faced by physicians to both diagnose and treat pain syndromes and identify individuals at risk for addictive disorders, the use of opioids in the treatment of pain poses a significant clinical challenge. Approach This paper reviews the interaction between pain and opioid addiction with a focus on clinical management issues, including risk factors for opioid dependence in patients with chronic pain and the use of assessment tools to identify and monitor at-risk individuals. Treatment options for opioid dependence and pain are reviewed, including the use of the partial μ agonist buprenorphine in the management of concurrent pain and opioid addiction. Implications Physicians should strive to find a reasonable balance between minimising potential adverse effects of opioid medications without diminishing legitimate access to opioids for analgesia. Conclusions The article discusses the need to identify methods for minimising risks and negative consequences associated with opioid analgesics and poses research directions, including the development of abuse-deterrent opioid formulations, genetic risk factors for opioid dependence and opioid-induced hyperalgesia as a potential target for medication therapy.

A European Community Pharmacy-Based Survey to Investigate Patterns of Prescription Fraud through Identification of Falsified Prescriptions

“…The other opioid analgesic identified in this study was morphine, which showed a high falsification ratio in Spain, although official utilization in the same country was low, as underlined in international reports [45]. Even though less accessibility to strong opioids in participating countries might explain why opioid analgesics are not the most frequently reported diverted drugs [45], by contrast with observations in the USA [46,47,48], the most recent data indicate an increasing use of opioid analgesics in all European countries [44,49] and an increasing trend in diversion [3,15]. The need to limit the consequences of potential abuse of these substances (and the subsequent limitations) should not affect their access for pain management.…”

Transgenerational modification of hippocampus TNF-α and S100B levels in the offspring of rats chronically exposed to morphine during adolescence

“…In addition, because of their narcotic effects, use of and addiction to opioids are increasing in some populations (3,4). The long-term presence of opiates in the neuronal environment produces various permanent modifications in neural functions of the brain (5-7).…”

Best Practices and Innovations for Managing Codeine Misuse and Dependence

“…Jurisdictions with OTC availability of codeine containing products should consider all best practices and innovations prior to up-scheduling. POM availability is not without its problems in terms of both over-prescribing and reducing access to a wide range of people who legitimately use codeine in favour of a minority who are codeine/opioid dependent (5,54,55). These issues require responsible and meaningful consideration by all stakeholders.…”