Researchers from the Cleveland Clinic examined the association of nonopioid substance abuse disorders, opioid dosage, and therapeutic opioid abuse (TOA). The authors hypothesized that a history of nonopioid substance abuse disorders and increasing opioid dosages would be associated with increased likelihood for TOA. Their findings, reported in Journal of Pain, conclude that a significant linkage does indeed exist between the variables. The study consisted of a retrospective analysis of 199 patients under treatment for chronic noncancer pain.
The researchers found that 44% of the study cohort were diagnosed with TOA. For those patients with a known history of substance abuse the incidence of TOA was 83%. The corresponding percentage for those without such history was just 25%. The findings underscore the importance of gathering a comprehensive substance abuse history prior to administering opioid therapy for patients with chronic noncancer pain. Adequate risk assessment, including diligent monitoring and use of an enforced opioid contract, should also be taken when prescribing to a patient with a known substance abuse history.
Read a news story about the findings here.
You’ll also find much more from our PAINWeek faculty on risk assessment and opioid prescribing in the Expert Opinion and Brainfood sections of our website.