Patients with chronic pain may be helped by strong pain relievers such as narcotics referred to as opioids. An opioid is a chemical substance that acts like morphine in the body. But these medications can be addictive, so there’s some concern about misuse and abuse.
In this study, researchers from the University of Washington reviewed articles from 1966 to 2007. They were looking for ways to predict who might be at risk for opioid misuse and/or abuse. Having this information would help physicians prescribe opioids. The goal is to help doctors choose patients who can benefit from this drug who are not at-risk for addiction.
Various methods were used to assess for patient behaviors suggesting opioid abuse. Depending on gut feelings was not reliable. Having patients fill out a survey answering questions about behaviors was also unreliable.
Urine screening may be the most accurate method of drug testing. But this isn’t as predictive of future behavior as it is an indicator of current drug misuse/abuse. Drug screening before prescribing opioids doesn’t really help sort out patients who are at-risk from those who aren’t.
Younger age does seem to increase the risk of medication misuse. But the role of gender (male versus female) was not clear. Most studies showed that women are not at increased risk for opioid abuse. The relationship between men and drug misuse was not as clear.
Probably the strongest predictor of drug misuse is a history of previous alcohol or other drug use. A family history of substance abuse may also be predictive. But this hasn’t been studied enough to say for sure. When used as prescribed, narcotic medications can be very effective without creating dependence and/or addiction. Signs that there may be a problem with misuse and/or abuse include:
Sometimes what looks like drug addiction is really just poorly controlled pain. If the patient is using more drug than was prescribed, hoarding drugs, or complaining about the need for more medication, then a follow-up evaluation with the physician is needed.
Other possible predictors include a history of car accidents, driving under the influence (DUI), and prior drug convictions. Mood disorders (such as depression) aren’t as likely to be present before the pain problem developed. But depressive disorders are five times more likely after disabling pain occurs. And ten times as many patients with opioid dependence develop a major depressive disorder after their injury.
The authors conclude that identifying patients who are at risk for drug misuse is a difficult challenge. There isn’t a good screening tool to use at present. More research is needed to find a reliable and valid way to measure all patients regardless of age, gender, or race. Until then, physicians must continue to monitor patients closely.