Dependence on Prescription Opioids.

Area of Science:

• Pain Management
• Pharmacology
• Public Health

Background:

• Opioid prescriptions for chronic non-cancer pain increased significantly in Germany (37% from 2000-2010).
• Prescribing practices often deviate from current clinical guidelines.
• Opioid dependence affects 8-12% of chronic non-cancer pain patients in the USA.

Purpose of the Study:

• To review current guidelines and literature on long-term opioid use for non-cancer pain.
• To identify risk factors and strategies for preventing opioid dependence and abuse.
• To inform physicians on managing opioid therapy and recognizing potential abuse.

Main Methods:

• Selective PubMed search for relevant publications.
• Inclusion of the German S3 guideline on long-term opioid use in non-cancer pain.
• Analysis of risk factors for opioid abuse, including age and history of substance abuse.

Main Results:

• Informed patient counseling on opioid effects and risks is essential before prescription.
• Regular review of opioid prescriptions for chronic non-cancer pain patients is recommended.
• High risk of abuse observed in young adults (OR=6.74) and those with substance abuse history (OR=2.34).
• Unusual medication-related behaviors warrant physician assessment and patient discussion.
• Urine testing can aid in detecting drug abuse.
• Opioid abstinence through dose reduction is the primary treatment goal for abuse; hospitalization or substitution therapy may be necessary.

Conclusions:

• Physician knowledge of opioid indications, risks, and patient behaviors aids in risk identification and prevention.
• Further studies on opioid abuse and dependence prevalence in German chronic pain patients are needed for better understanding and management.