Dependence and addiction during chronic opioid therapy

Area of Science:

• Pain Management
• Addiction Medicine
• Pharmacology

Background:

• Opioid prescribing for chronic noncancer pain has surged in North America, paralleling increases in addiction and overdose deaths.
• Concerns regarding alternative pain medications, like NSAIDs, contributed to increased opioid use.
• The 1990s saw widespread communication to physicians asserting low, predictable risks of dependence and addiction with chronic opioid therapy.

Purpose of the Study:

• To critically appraise publications cited as evidence for low addiction risk during chronic opioid therapy.
• To evaluate the scientific basis for the assertion that opioid addiction is rare in chronic pain management.

Main Methods:

• Narrative review of frequently cited publications.
• Critical appraisal of study methodologies and conclusions.
• Comparison of older cited studies with contemporary evidence.

Main Results:

• Very few well-designed studies support the claim of rare opioid addiction during chronic therapy.
• Cited studies often have significant methodological limitations and are mischaracterized.
• Contemporary evidence shows dependence and addiction are common, occurring in up to 33% of patients in some studies.

Conclusions:

• The notion of rare opioid addiction during chronic opioid therapy is largely unsupported by rigorous scientific evidence.
• Methodological flaws in older studies have led to their misinterpretation.
• Current evidence indicates a higher prevalence of opioid dependence and addiction than previously asserted.