Prescription Opioids: Risk Management and Strategies for Safe Use _ _________________________________ and IV criteria include tolerance and withdrawal as diagnostic criteria, which can reflect physical dependence that is an expected development of long-term opioid therapy. Other DSM diagnostic criteria may also describe common non-addiction based experiences of patients with pain who are receiving long-term opioid therapy, such as using the medication in higher amounts or for a longer term than intended and a persistent desire or unsuccess- ful attempts to cut down, control, or halt the use of the opioids [80]. Also, DSM criteria require the patient experience of impaired function or distress resulting from their opioid use. Many of those with chronic pain report clinically significant dysfunc- tion and distress from their chronic pain; some studies do not clarify whether pain or the opioid is causing the reported dysfunction and distress. For these reasons, more recent pain researchers have concluded that DSM criteria are not applicable and may be misleading as a diagnostic basis in patients with chronic pain [78; 81]. Treatment Admissions for Opioid Use Disorders Among persons 12 years of age or older with a past- year opioid use disorder due to their use of heroin or misuse of prescription pain relievers, 22.1% (533,000 people) received medication-assisted treat- ment in the past year [73]. Diversion of Prescription Opioids
Research has more closely defined the location of prescribed opioid diversion into illicit use in the sup- ply chain from the manufacturer to the distributor, retailer, and the end user. This information carries with it substantial public policy and regulatory impli- cations. The 2021 NSDUH data asked nonmedical users of prescription opioids how they obtained their most recently used drugs [73]. Among persons 12 years of age or older, 33.9% obtained their prescrip- tion opioids from a friend or relative for free, 39.3% got them through a prescription from one doctor (vs. 34.7% in 2018), 7.3% bought them from a friend or relative, and 7.9% bought them from a drug dealer or other stranger. Less frequent sources included stealing from a friend or relative (3.7%); multiple doctors (3.2%); theft from a doctor’s office, clinic, hospital, or pharmacy (0.7%) (vs. 0.7% in 2018); and some other way (4.0%) [73]. Neonatal Abstinence Syndrome (NAS) Rates of opioid misuse may also be tracked by unin- tended effects of use during pregnancy on newborns. Cases of neonatal abstinence syndrome (NAS)—a group of problems that can occur in newborns exposed to prescription opioids or other drugs while in the womb—grew by 83% in the United States between 2010 and 2017 [84]. OPIOID ANALGESIC- RELATED MORTALITY Opioid analgesics may result in deaths due to unin- tentional or intentional overdose or intoxication- related accidents. However, the majority of data focus on unintentional overdose. The rates of fatal toxicity involving prescription opioid analgesics have escalated in tandem with the increasing rates in opioid analgesic prescribing, abuse, addiction, and diversion. Unfortunately, additional valuable infor- mation is not revealed by the mortality data, such
One study that controlled for the improper fit of DSM opioid addiction criteria in patients receiv- ing long-term opioid therapy followed a group of patients with sickle cell anemia [82]. Researchers found that 31% of patients receiving opioids devel- oped opioid dependence according to the DSM-IV criteria. When pain-related symptoms that actu- ally accounted for positive diagnostic criteria were removed, the addiction incidence fell to 2% [82]. In a review of 24 studies enrolling 2,507 patients with chronic pain with a 26.2-month average duration of opioid therapy, the overall opioid addiction rate was 3.27% [79]. A 2013 study evaluated the rate of drug misuse and illicit use in 1,350 patients with a pain duration greater than one year who were currently prescribed opioids for three months or longer and enrolled in an interventional pain program. The study found that 1.3% were using non-prescribed prescription drugs and 7.9% were using illicit drugs (primarily cannabis; substantially fewer for cocaine and methamphetamine). The authors concluded the rates they found in patients receiving opioids were comparable to those of the general population [83].
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MDMS1526
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