Strategies to Identify Patient Risks of Prescription Opioid Addiction When Initiating Opioids for Pain: A Systematic...

Area of Science:

• Medical research
• Clinical pharmacology
• Addiction medicine

Background:

• Prescription opioid use disorder presents significant public health challenges.
• Effective strategies for identifying patients who can safely use prescription opioids for pain management are lacking.

Purpose of the Study:

• To systematically review evidence on factors associated with opioid addiction.
• To evaluate screening tools for identifying adult patients at high or low risk of prescription opioid addiction.

Main Methods:

• A comprehensive search of MEDLINE and Embase databases was conducted (1946-2018).
• Included studies compared risk factors and screening tools in patients who developed opioid addiction versus those who did not.
• Data extraction and quality assessment followed PRISMA-DTA guidelines, calculating likelihood ratios (LRs).

Main Results:

• Four high-quality studies involving over 2.8 million patients were synthesized.
• A history of opioid or other substance use disorder, specific mental health diagnoses (e.g., personality disorder), and certain psychiatric medications increased addiction risk (LRs 4.2-27).
• Most widely used screening tools demonstrated poor performance in identifying high or low-risk patients.

Conclusions:

• History of substance use disorder, certain mental health conditions, and concurrent psychiatric medication use are key indicators for high opioid addiction risk.
• Few reliable methods exist to identify patients at low risk for prescription opioid addiction.
• Further research is needed to develop accurate screening tools for safe opioid prescribing.