Risk factors in opioid use disorders In general, individuals take opioids and other intoxicating substances for a variety of reasons, including (1) pleasure; (2) an escape from social anxiety, stress, and depression; (3) to increase performance; and (4) curiosity and social pressure. No single factor determines whether an individual becomes addicted to drugs, and factors can be biological or environmental. 71 Biological influences in persons with OUD include genetics, gender, and mental health disorders, while environmental influences include chaotic home situations, parental use and attitudes, peer influences, community attitudes, and low academic achievement. Risk factors for substance abuse include (1) aggressive behavior in childhood, (2) lack of parental supervision, (3) peer refusal skills, (4) drug experimentation, (5) availability of drugs at school, and (6) community poverty. Protective factors reduce an individual’s The clinical practice guideline is intended for clinicians treating adult outpatients over the age of 18 with acute, subacute, or chronic pain and specifically excludes pain management related to chronic conditions such as sickle cell disease, cancer- related pain, palliative care, and end-of-life care. 80 The guideline is intended to assist clinicians in weighing the risks and benefits of prescribing opioid pain medication for acute painful conditions such as musculoskeletal pain, neuropathic pain, and pain related to operative procedures. The CDC Clinical Practice Guidelines for Prescribing Opioids for Pain are as follows 80 : 1. Nonopioid therapies are at least as effective as opioids for many common types of acute pain. Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider opioid therapy for acute pain if benefits are anticipated to outweigh risks to the patient. Before prescribing opioid therapy for acute pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy. 2. Nonopioid therapies are preferred for subacute and chronic pain. Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider initiating opioid therapy if expected benefits for pain and function are anticipated to outweigh risks to the patient. Before starting opioid therapy for subacute or chronic pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy, should work with patients to establish treatment goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks. 3. When starting opioid therapy for acute, subacute, or chronic pain, clinicians should prescribe
risk of substance use and include (1) self-efficacy affected by personal and home situations, (2) parental monitoring and support, (3) positive relationships, (4) extracurricular activities, (5) antidrug policies at school, and (6) neighborhood resources. 72 One of the most important changes during development in adolescence is the maturing prefrontal cortex, which is responsible for assessment of situations, making sound decisions, and keeping emotions and desires under control. 73 As these complexities are not yet fully developed, the adolescent appears at a greater risk of initiating substance use. Introducing substance use during this time can interrupt the development of neuronal connections that may lead to permanent changes in the ways in which these connections operate as the individual ages. immediate-release opioids instead of extended- release and long-acting (ER/LA) opioids. 4. When opioids are initiated for opioid-naïve patients with acute, subacute, or chronic pain, clinicians should prescribe the lowest effective dosage. If opioids are continued for subacute or chronic pain, clinicians should use caution when prescribing opioids at any dosage, should carefully evaluate individual benefits and risks when considering increasing dosage, and should avoid increasing dosage above levels likely to yield diminishing returns in benefits relative to risks to patients. 5. For patients already receiving opioid therapy, clinicians should carefully weigh benefits and risks and exercise care when changing opioid dosage. If benefits outweigh risks of continued opioid therapy, clinicians should work closely with patients to optimize nonopioid therapies while continuing opioid therapy. If benefits do not outweigh risks of continued opioid therapy, clinicians should optimize other therapies and work closely with patients to gradually taper to lower dosages or, if warranted based on the individual circumstances of the patient, appropriately taper and discontinue opioids. Unless there are indications of a life- threatening issue such as warning signs of impending overdose (e.g., confusion, sedation, or slurred speech), opioid therapy should not be discontinued abruptly, and clinicians should not rapidly reduce opioid dosages from higher dosages. 6. When opioids are needed for acute pain, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. 7. Clinicians should evaluate benefits and risks with patients within one to four weeks of starting opioid therapy for subacute or chronic pain or of dosage escalation. Clinicians should regularly reevaluate benefits and risks of continued opioid therapy with patients.
CDC clinical practice guidelines for prescribing opioids for pain Due to the risks involved with the use of opioids in any form, a clinical practice guideline was established.
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Book Code: TN24CME
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