Skip to main content
Article
Prescription opioid abuse in chronic pain: An updated review of opioid abuse predictors and strategies to curb opioid abuse (Part 2)
Pain Physician
  • Alan David Kaye, Louisiana State University Health Science Center
  • Mark R. Jones, Louisiana State University Health
  • Adam M. Kaye, University of the Pacific
  • Juan G. Ripoll, Mayo Clinic in Jacksonville, Florida
  • Donald E. Jones, Louisiana State University Health
  • Vincent Galan, Tulane University School of Medicine
  • Burton D. Beakley, Tulane University School of Medicine
  • Francisco Calixto, Tulane University School of Medicine
  • Jamie L. Bolden, Louisiana State University Health
  • Richard D. Urman, Harvard University
  • Laxmaiah Manchikanti, Pain Management Center Paducah
ORCiD
Adam M. Kaye: 0000-0002-7224-3322
Document Type
Article
Publication Date
2-1-2017
Abstract

Chronic pain and prescription opioid abuse are extremely prevalent in the United States and worldwide. The consequences of opioid misuse can be life-threatening with significant morbidity and mortality, exacting a heavy toll on patients, physicians, and society. The risk for misuse of prescribed opioids is much higher in patients with chronic pain, especially those with concurrent substance use and /or mental health disorders. Several reasons can account for the occurrence of opioid abuse and misuse, including self-medication, use for reward, compulsive use related to addiction, and diversion for profit. There is a need, therefore, for therapeutic approaches that balance treating chronic pain, while minimizing risks for opioid abuse, misuse, and diversion. Chronic opioid therapy for chronic non-cancer pain has seen a dramatic increase throughout the past 2 decades in conjunction with associated increases in the abuse of prescribed opioids and accidental opioid overdoses. Consequently, a validated screening instrument that provides an effective and rational method for selecting patients for opioid therapy, predicting risk, and identifying problems once they have arisen, could be of enormous benefit in clinical practice. An instrument as such has the potential to attenuate the risk of iatrogenic addiction. Despite the recent introduction of various screening strategies and instruments, no single test or instrument can reliably and accurately predict those patients unsuitable for opioid therapy or pinpoint those requiring heightened degrees of surveillance and monitoring throughout their therapy. Current opioid abuse screening tactics include assessing premorbid and comorbid substance abuse; assessing aberrant drug-related behaviors; stratification of risk factors; and utilizing opioid assessment screening tools. Several authors have contributed numerous screening tools and instruments to aid the assessment of appropriate opioid therapy. Additional essential measures include urine drug testing, prescription practice monitoring programs, opioid treatment agreements, and implementing universal precautions. Presently accepted recommendations consist of a combination of strategies designed to stratify risk, to identify and to understand aberrant drug-related behaviors, and to tailor treatments accordingly. This manuscript, Part 2 of a 2 part update, builds on the 2012 opioid guidelines published in Pain Physician, and the 2016 guidelines released by the Centers for Disease Control and Prevention. It reviews screening, monitoring, and addressing opioid abuse and misuse in patients with chronic non-cancer pain.

Creative Commons License
Creative Commons Attribution-NonCommercial 4.0 International
Citation Information
Alan David Kaye, Mark R. Jones, Adam M. Kaye, Juan G. Ripoll, et al.. "Prescription opioid abuse in chronic pain: An updated review of opioid abuse predictors and strategies to curb opioid abuse (Part 2)" Pain Physician Vol. 20 Iss. 2 (2017) p. S111 - S133 ISSN: 2150-1149
Available at: http://works.bepress.com/adam-kaye/110/