title: [Misuse and dependence on prescription opioids: Prevention, identification and treatment].
abstract: Since the 1990s, the use of prescription opioids has largely spread, which has brought a real progress in the treatment of pain. The long-term use of prescription opioid is sometimes required, and may lead to pharmacological tolerance and withdrawal symptoms, i.e. pharmacological dependence on prescription opioids. Occasionally, this may also lead to misuse of prescription opioids (MPO). MPO preferentially occurs in vulnerable individuals, i.e., those with a young age, history of other addictive or psychiatric disorders, especially anxious and depressive disorders. MPO is associated with numerous complications, including an increased risk of fatal overdose. Prevention of MPO begins before the opioid prescription, with the identification of potential vulnerability factors. A planned and personalized monitoring should be systematically implemented. In vulnerable patients, contractualizing the prescription is warranted. During follow-up, the relevance of the prescription should be regularly reconsidered, according to the benefit observed on pain and the potential underlying signs of MPO. Patients with suspected MPO should be referred early to pain or addiction centers. The treatment of MPO should be based on multidisciplinary strategies, involving both the addiction and pain aspects: progressive opioid withdrawal, non-pharmacological measures against pain, or switching to medication-assisted treatment of addiction (i.e., buprenorphine or methadone).
authors.affiliation: Service d'addictologie, hôpital Fontan 2, CHRU de Lille, CS 70001, 59037 Lille cedex, France. Electronic address: benjrolland@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Rolland
authors.affiliation: Inserm U-987, centre d'évaluation et de traitement de la douleur, hôpital Ambroise-Paré, 92100 Boulogne-Billancourt, France.
authors.forename: D
authors.initials: D
authors.lastname: Bouhassira
authors.affiliation: UMR Inserm 1107, faculté de médecine, pharmacologie médicale, CRPV/CEIP/CETD, centre d'évaluation et de traitement de la douleur/institut Analgesia, CHU de Clermont-Ferrand, F-63000 Clermont-Ferrand, France.
authors.forename: N
authors.initials: N
authors.lastname: Authier
authors.affiliation: Université de Bordeaux et CNRS USR 3413 (sanpsy), pôle addictologie, CH Ch. Perrens et CHU de Bordeaux, 33076 Bordeaux, France.
authors.forename: M
authors.initials: M
authors.lastname: Auriacombe
authors.affiliation: Service d'anesthésie, hôpital Raymond-Poincaré, 92380 Garches, France.
authors.forename: V
authors.initials: V
authors.lastname: Martinez
authors.affiliation: Service d'addictologie, hôpital René-Muret, hôpitaux universitaires Paris Seine-Saint-Denis, 93270 Sevran, France.
authors.forename: P
authors.initials: P
authors.lastname: Polomeni
authors.affiliation: Service de psychiatrie B, CHU, hôpital Gabriel-Montpied, F-63003 Clermont-Ferrand, France.
authors.forename: G
authors.initials: G
authors.lastname: Brousse
authors.affiliation: Pôle hospitalo-universitaire de psychiatrie d'adultes du Nancy, centre psychothérapique de Nancy, 54520 Laxou, France.
authors.forename: R
authors.initials: R
authors.lastname: Schwan
authors.affiliation: CSAPA, hôpital de la Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Lack
authors.affiliation: CSAPA centre Port-Bretagne, CHU de Tours, 37000 Tours, France.
authors.forename: J
authors.initials: J
authors.lastname: Bachellier
authors.affiliation: Hôpital Saint-Antoine, centre d'évaluation et de traitement de la douleur, 75012 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Rostaing
authors.affiliation: Service de psychiatrie, secteur 2, CH de La Rochelle, 17019 La Rochelle, France.
authors.forename: P
authors.initials: P
authors.lastname: Bendimerad
authors.affiliation: Service de rhumatologie et centre de la douleur, CHU de Limoges, 87042 Limoges, France.
authors.forename: P
authors.initials: P
authors.lastname: Vergne-Salle
authors.affiliation: Service d'addictologie, CHU de Grenoble-Alpes, université Grenoble-Alpes, 38700 La Tronche, France.
authors.forename: M
authors.initials: M
authors.lastname: Dematteis
authors.affiliation: Inserm U-987, centre de la douleur, hôpital Hôtel-Dieu, université Paris-Descartes, 75014 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Perrot
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy / Q000453:epidemiology; D003937:Diagnosis, Differential; D006801:Humans; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D063487:Prescription Drug Misuse / Q000517:prevention & control / Q000706:statistics & numerical data
chemical_list: D000701:Analgesics, Opioid
keywords: Abus de médicaments sur ordonnance; Analgésiques morphiniques; Centres antidouleur; Chronic Pain; Douleur chronique; Identification; Opioid analgesics; Opioid substitution treatments; Opioid use disorders; Pain clinics; Prescription drug abuse; Prevention; Prévention; Repérage; Traitements de substitution aux opiacés; Troubles liés aux opiacés