Wednesday, February 25, 2015 7:18:38 AM
CJ Arlotta 2/25/2015 @ 7:00AM
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Physicians prescribing opioids are more often than not looking for ways to evaluate patients more effectively. Knowing more about a patient’s history can assist practitioners with making decisions on pain management treatment options. Understanding a patient’s struggle with substance abuse could be a good place to start.
A report published in The Journal of Pain, the official journal of the American Pain Society, concluded that the history of substance abuse can predict the misuse of therapeutic opioids. For the study, researchers from the Cleveland Clinic, a non-profit academic medical center, observed 199 patients treated for chronic non-cancer pain. Their goal: Find out if there’s any kind of linkage between non-opioid substance abuse disorders, opioid dosage and therapeutic opioid abuse.
“Cross addiction is a well-studied phenomenon in which patients recovering from one substance are encouraged to avoid all mind altering substances,” said Dr. Sylvester Sviokla, owner and medical director of Medical Assisted Recovery, a substance abuse clinic based out of Warwick, Rhode Island, in an interview.
Patients in the study underwent “rigorous and comprehensive diagnostic evaluations” to increase the likelihood of researchers detecting any subtle symptoms of an active substance disorder, the study’s authors noted. According to them, other studies have used methods prone to underreporting. These approaches include physician reporting and retrospective review of medical records for diagnosis.
To qualify for the research, patients needed to be undergoing long-term opioid therapy at the time of admission or had been through chemical dependency treatment for opioids directly before admission. Cases were excluded if patients had a history of non-medicinal opioid use before being introduced to therapeutic opioids, had abused therapeutic opioids but did not meet the criteria for therapeutic opioid abuse or researchers could not conclusively diagnose therapeutic opioid abuse. The criteria for therapeutic opioid abuse was based on consensus definitions of several medical texts.
Researchers found that 25% of patients with no known history of a substance use disorder had therapeutic opioid abuse. In patients with a known history of substance abuse disorders, 83% had therapeutic opioid abuse. The study also revealed that patients with substance use disorders are more likely to receive opioids in higher dosages.
Dr. Wilson Compton, deputy director at the National Institute on Drug Abuse (NIDA), a federal government research institute, told Forbes that the results of this report are similar to the findings of previous studies on the topic.
“Understanding who is at risk for developing addiction to prescription opioids is important for determining the best treatment options for a given patient,” he said. “This study supports the observation that a prior substance use disorder increases the chances of developing addition to prescription opioids.”
Compton suggests that prescribers use alternatives to opioids whenever possible. “When opioids must be prescribed, the dosage and pattern of use should be monitored very closely. Family should be involved in care.”
Chronic pain has been at the center of the debate over how physicians can make a dent in opioid addiction. More than 100 million Americans suffering from chronic pain are waiting for a solution from physicians that can minimize the risk of becoming dependent on prescription painkillers
“It is in my opinion, shared by many in my field, although not all, that opioids for chronic pain (not caused by invasive cancer) should never be used,” Sviokla said.
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