title: Prescription opioid abuse, pain and addiction: clinical issues and implications.
abstract: OBJECTIVE
  Prescription opioid misuse in the USA has increased over threefold since 1990 to epidemic proportions, with substantial increases in prescription opioid use also reported in other countries, such as Australia and New Zealand. The broad availability of prescription pain medications, coupled with public misconceptions about their safety and addictive potential, have contributed to the recent surge in non-medical use of prescription opioids and corresponding increases in treatment admissions for problems related to opioid misuse. Given competing pressures faced by physicians to both diagnose and treat pain syndromes and identify individuals at risk for addictive disorders, the use of opioids in the treatment of pain poses a significant clinical challenge.
  
  
  METHODS
  This paper reviews the interaction between pain and opioid addiction with a focus on clinical management issues, including risk factors for opioid dependence in patients with chronic pain and the use of assessment tools to identify and monitor at-risk individuals. Treatment options for opioid dependence and pain are reviewed, including the use of the partial µ agonist buprenorphine in the management of concurrent pain and opioid addiction.
  
  
  CONCLUSIONS
  Physicians should strive to find a reasonable balance between minimising potential adverse effects of opioid medications without diminishing legitimate access to opioids for analgesia.
  
  
  CONCLUSIONS
  The article discusses the need to identify methods for minimising risks and negative consequences associated with opioid analgesics and poses research directions, including the development of abuse-deterrent opioid formulations, genetic risk factors for opioid dependence and opioid-induced hyperalgesia as a potential target for medication therapy.
authors.affiliation: UCLA Integrated Substance Abuse Programs, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90025-7539, USA
authors.forename: Walter
authors.initials: W
authors.lastname: Ling
authors.forename: Larissa
authors.initials: L
authors.lastname: Mooney
authors.forename: Maureen
authors.initials: M
authors.lastname: Hillhouse
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D016739:Behavior, Addictive / Q000453:epidemiology* / Q000523:psychology; D002908:Chronic Disease; D006801:Humans; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D055553:Prescription Drugs / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs