Both chronic pain and prescription opioid abuse are prevalent and continue to exact a heavy
toll on patients, physicians, and society. Individuals with chronic pain and co-occurring
substance use disorders and/or mental health disorders, are at a higher risk for misuse of
prescribed opioids. Opioid abuse and misuse occurs for a variety of reasons, including self
medication, use for reward, compulsive use because of addiction, and diversion for profit.
Treatment approaches that balance treating chronic pain while minimizing risks for opioid
abuse, misuse, and diversion are much needed. The use of chronic opioid therapy for chronic
noncancer pain has increased dramatically in the past 2 decades in conjunction with a marked
increase in the abuse of prescribed opioids and accidental opioid overdoses. Consequently,
a validated screening instrument that provides an effective and rational method of selecting
patients for opioid therapy, predicting risk, and identifying problems once they arise could
be of enormous benefit. Such an instrument could potentially curb the risk of iatrogenic
addiction. Although several screening instruments and strategies have been introduced
in the past decade, there is no single test or instrument that can reliably and accurately
predict patients who are not suitable for opioid therapy or identify those who need increased
vigilance or monitoring during therapy.
At present, screening for opioid abuse includes assessment of premorbid and comorbid
substance abuse; assessment of aberrant drug-related behaviors; risk factor stratification; and
utilization of opioid assessment screening tools. Multiple opioid assessment screening tools
and instruments have been developed by various authors. In addition, urine drug testing,
monitoring of prescribing practices, prescription monitoring programs, opioid treatment
agreements, and utilization of universal precautions are essential. Presently, a combination
of strategies is recommended to stratify risk, identify and understand aberrant drug related
behaviors, and tailor treatments accordingly.
This manuscript will review the current state of knowledge regarding the growing problem
of opioid abuse and misuse; known risk factors; and methods of predicting, assessing,
monitoring, and addressing opioid abuse and misuse in patients with chronic noncancer pain.
Key words: Opioids, misuse, abuse, chronic pain, prevalence, risk assessment, risk
management, drug monitoring, aberrant drug-related behavior
Association Between Prescription Opioid Therapy for Noncancer Pain and Hepatitis C Virus Seroconversion
