What Percentage of Chronic Nonmalignant Pain Patients Exposed to Chronic Opioid Analgesic Therapy Develop Abuse/Addiction and/or Aberrant Drug-Related Behaviors? A Structured Evidence-Based Review

Fishbain, David A.; Cole, Brandly; Lewis, John E.; Rosomoff, Hubert L.; Rosomoff, R. Steele

doi:10.1111/j.1526-4637.2007.00370.x

Cited by 497 publications

(366 citation statements)

References 90 publications

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“…Another meta-analysis conducted to determine the percentage of CNCP patients exposed to COT develop addiction and/ or aberrant drug-related behaviors concluded that Bthe results of this evidence-based structured review indicate that COT exposure will lead to abuse/addiction in a very small percentage of patients. This percentage can be dramatically decreased by preselecting CNCP patients, who have no previous/current history of drug/alcohol abuse/addiction^ [8]. Aberrant drug-related behavior (ADRB) rates in the range of 15 % seem more realistic than addiction rates.…”

Section: Chronic Pain and Opioid Therapymentioning

confidence: 99%

Chronic Pain, Chronic Opioid Addiction: a Complex Nexus

Salsitz

2015

J. Med. Toxicol.

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Over the past two decades, there has been a significant increase in the prescribing of opioids, with associated increases in opioid addiction and overdose deaths. This article reviews the evidence for the effectiveness and risk of developing an opioid use disorder (OUD) in those patients treated with chronic opioid therapy (COT) for chronic non-cancer pain (CNCP). Rates of development of OUD range from 0-50 %, and aberrant drug related behaviors (ADRBs) are reported to be 20 %. Health care providers must properly assess, screen, and carefully monitor patients on COT utilizing evidence-based tools.

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Section: Chronic Pain and Opioid Therapymentioning

confidence: 99%

Chronic Pain, Chronic Opioid Addiction: a Complex Nexus

Salsitz

2015

J. Med. Toxicol.

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“…A case in point is provided by Richard Feynman, a Nobel laureate in physics, who stopped drinking alcohol upon noticing that it was becoming involuntary--because he felt that it would be threatening the pleasure he derived from his thinking [51]. Tellingly, among individuals exposed to chronic opioid analgesic therapy (COAT), less than 0.1 % becomes addicted de novo, while overall illicit drug use among COAT patients does not exceed its prevalence in the general population [52].…”

Section: Systematic Reviewsmentioning

confidence: 99%

Risk and resistance perspectives in translation-oriented etiology research

Vanyukov

Tarter

Conway

et al. 2015

Behav. Med. Pract. Policy Res.

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Risk for a disorder and the mechanisms that determine its elevation, risk factors, are the focus of medical research. Targeting risk factors should serve the goal of prevention and treatment intervention. Risk, however, is but one of the aspects of liability to a disorder, a latent trait that encompasses effects of all factors leading to or from the diagnostic threshold. The coequal but opposite aspect of liability is resistance to a disorder. The factors that increase resistance and thus enable prevention or recovery may differ from those that elevate risk. Accordingly, there are nontrivial differences between research perspectives that focus on risk and on resistance. This article shows how this distinction translates into goals and methods of research and practice, from the choice of potential mechanisms tested to the results sought in intervention. The resistance concept also differs from those of Bresilience^and Bprotective factors,^subsuming but not limited to them. The implications of the concept are discussed using substance use disorder as an example and substantiate the need for biomedical research and its translation to shift to the resistance perspective. Keywords

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“…[3] Results of a structured evidence-based review suggest that abuse develops in <5% of chronic pain patients treated with prescription opioid analgesics, although rates of abuse varied considerably across individual studies. [4] Nevertheless, it is estimated that approximately 33 million people -or 0.7% of the world's adult population -currently abuse prescription or nonprescription opioids. [2] In 2014, approximately 4.3 million individuals aged 12 years or older (1.6% of the population aged 12 or older) reported non-medical use of prescription opioid analgesics in the USA, making prescription opioid analgesics the second most commonly abused drug class after marijuana.…”

Section: Introductionmentioning

confidence: 99%

Routes of abuse of prescription opioid analgesics: a review and assessment of the potential impact of abuse-deterrent formulations

Gąsior

Bond

Malamut

2015

Postgraduate Medicine

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Prescription opioid analgesics are an important treatment option for patients with chronic pain; however, misuse, abuse and diversion of these medications are a major global public health concern. Prescription opioid analgesics can be abused via intended and non-intended routes of administration, both intact or after manipulation of the original formulation to alter the drug-delivery characteristics. Available data indicate that ingestion (with or without manipulation of the prescribed formulation) is the most prevalent route of abuse, followed by inhalation (snorting, smoking and vaping) and injection. However, reported routes of abuse vary considerably between different formulations. A number of factors have been identified that appear to be associated with non-oral routes of abuse, including a longer duration of abuse, younger age, male sex and a rural or socially deprived location. The development of abuse-deterrent formulations of prescription opioid analgesics is an important step toward reducing abuse of these medications. Available abuse-deterrent formulations aim to hinder extraction of the active ingredient, prevent administration through alternative routes and/or make abuse of the manipulated product less attractive, less rewarding or even aversive. There are currently five opioid analgesics with a Food and Drug Administration abuse-deterrent label, and a number of other products are under review. A growing body of evidence suggests that introduction of abuse-deterrent opioid analgesics in the USA has been associated with decreased rates of abuse of these formulations. The availability of abuse-deterrent formulations therefore appears to represent an important step toward curbing the epidemic of abuse of prescription opioid analgesics, while ensuring the availability of effective pain medications for patients with legitimate medical need.

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What Percentage of Chronic Nonmalignant Pain Patients Exposed to Chronic Opioid Analgesic Therapy Develop Abuse/Addiction and/or Aberrant Drug-Related Behaviors? A Structured Evidence-Based Review

Cited by 497 publications

References 90 publications

Chronic Pain, Chronic Opioid Addiction: a Complex Nexus

Chronic Pain, Chronic Opioid Addiction: a Complex Nexus

Risk and resistance perspectives in translation-oriented etiology research

Routes of abuse of prescription opioid analgesics: a review and assessment of the potential impact of abuse-deterrent formulations

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