__________________________________ Prescription Opioids: Risk Management and Strategies for Safe Use
TERMS TO AVOID OR LIMIT THE USE OF
Term
Rationale for not using
Addicted/addiction
Frequently misused by those untrained to make the diagnosis. Not all who abuse are addicted. Patently false when describing a substance. Addiction resides within the person and not in the substance used. Some drugs do have high abuse liability, but most persons do not respond to exposure with addictive behavior. Overused in the literature and by clinicians. Not very helpful, especially if a better treatment or coping strategy is not immediately available. Used when a patient is assumed to lack legitimate need for medication. Should be replaced with relief-seeking, if appropriate.
Addictive
Chemical coping
Drug-seeking
Hooked Slang for addicted. Assumes the absence of medical need for the substance and suggests an off-hand, bad attitude. Inebriated/intoxicated A snap conclusion when a patient suspected of taking medication or other substance displays an altered sensorium. Better to objectively describe observations. Malingering Overcalled and best not expressed unless there is legally valid proof of deception for illicit purposes. Narcotic A term formerly referring to opium, morphine, and heroin and still used in the area of law and misused by media in reference to all opioids. Should never be used in a clinical or education context due to strong emotional association with crime, addiction, and death. Best replaced with opioid.
Painkiller
Negative use by media in reports of opioid addiction and overdose. Best replaced with pain reliever.
Source: [19]
Table 3
CONSIDERATIONS FOR DIFFERENTIAL DIAGNOSES
• Aggressive demands for more drug • Asking for specific medications • Stockpiling medications during times when pain is less severe • Using pain medications to treat other symptoms • Reluctance to decrease opioid dosing once stable • In the earlier stages of treatment: − Increasing medication dosing without provider permission − Obtaining prescriptions from sources other than the pain provider − Sharing or borrowing similar medications from friends/family It is essential for clinicians to consider poorly man- aged pain or poor coping skills as the basis for aber- rant behavior. Even aberrant behaviors highly sug- gesting opioid abuse may reflect a patient’s attempt to feel normal or alleviate emotional or physical distress. This is termed chemical coping and refers
• Inadequate pain management: – Stable condition but inadequate pain control – Progressive condition/pathology – Tolerance to opioids • Inability to comply with treatment due to:
– Cognitive impairment – Psychiatric condition • Self-medication of mood, anxiety, sleep, post- traumatic stress disorder, etc. • Diversion Source: [19]
Table 4
• Recurrent episodes of:
− Prescription loss or theft − Obtaining opioids from other providers in violation of a treatment agreement − Unsanctioned dose escalation − Running out of medication and requesting early refills Behaviors with a lower level of evidence for their association with opioid misuse include [23; 24; 25]:
9
MDMS1526
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