title: Characterization of prescription opioid abuse in the United States: focus on route of administration.
abstract: Prescription opioids are prescribed increasingly for the management of chronic pain, and this has been accompanied by a dramatic rise in opioid-related abuse, addiction, and overdose deaths. Reports of abuse involving nonoral administration (e.g., snorting, injecting) of prescription opioids are increasing, although the epidemiology of oral versus nonoral abuse is not well understood. Available data indicate that oral abuse is far more common,with 72% to 97% of opioid abusers perferring oral administration. Factors associated with nonoral administration include longer duration of opioid abuse, male gender, and rural setting. Extended-release opioids, because of their relatively high drug load, may be attractive to experienced abusers seeking to manipulate the formulation to facilitate a rapid onset of effect. Putative abuse-deterrent formulations have been developed to decrease the likelihood or consequences of nonoral abuse. In addition, Risk Evaluation and Mitigation Strategies (REMS) are now required for prescribed extended-release/long-acting opioids by the US Food and Drug Administration, although their effectiveness in reducing the risk of abuse, addiction, and overdose has not been evaluated. Physicians should remain vigilant when prescribing opioids and should exercise appropriate patient selection, perform risk analysis and stratification, and maintain continuous patient monitoring to ensure the benefits outweigh these important risks.
authors.affiliation: BehavioralMedicine and Ancillary Services, The Pain Treatment Center of the Bluegrass,2416 Regency Road, Lexington, KY 40503, USA. doctorken@windstream.net
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kirsh
authors.forename: John
authors.initials: J
authors.lastname: Peppin
authors.forename: John
authors.initials: J
authors.lastname: Coleman
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage* / Q000506:poisoning; D002648:Child; D059350:Chronic Pain / Q000188:drug therapy*; D003692:Delayed-Action Preparations; D062787:Drug Overdose; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D010098:Oxycodone / Q000008:administration & dosage* / Q000506:poisoning; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D012424:Rural Population; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000700:Analgesics; D003692:Delayed-Action Preparations; D010098:Oxycodone