Misuse of and dependence on opioids: study of chronic pain patients.
OBJECTIVE
To review the evidence on identifying and managing misuse of and dependence on opioids among primary care patients with chronic pain.


METHODS
MEDLINE was searched using such terms as "opioid misuse" and "addiction." The few studies on the prevalence of opioid dependence in primary care populations were based on retrospective chart reviews (level II evidence). Most recommendations regarding identification and management of opioid misuse in primary care are based on expert opinion (level III evidence).


RESULTS
Physicians should ask all patients receiving opioid therapy about current, past, and family history of addiction. Physicians should take "universal precautions" that include careful prescribing and ongoing vigilance for signs of misuse. Patients suspected of opioid misuse can be treated with a time-limited trial of structured opioid therapy if they are not acquiring opioids from other sources. The trial should consist of daily to weekly dispensing, regular urine testing, and tapering of doses of opioids. If the trial fails or is not indicated, patients should be referred for methadone or buprenorphine treatment.


CONCLUSIONS
Misuse of and dependence on opioids can be identified and managed successfully in primary care.
Kahan
Meldon
M
Addiction Medical Service, St Joseph's Health Centre, Toronto, Ontario, Canada. kahanm@stjoe.on.ca
Srivastava
Anita
A
Wilson
Lynn
L
Gourlay
Douglas
D
Midmer
Deana
D
D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D004363:Drug Utilization; D004335:Drug and Narcotic Control; D004502:Education, Medical, Continuing; D005194:Family Practice / Q000592:standards / Q000639:trends; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy*; D010819:Physician's Role; D018570:Risk Assessment; D012720:Severity of Illness Index; D015813:Substance Abuse Detection / Q000379:methods*
D000701:Analgesics, Opioid