Progressive Opioid Use: Who’s At Risk?
Throughout the United States, greater attention is being paid to accidental overdoses from the long-term use of opioids. Experts have reported that there is an urgent need to better understand patterns of opioid prescribing. In most cases, healthcare providers do not prescribe opioids with the intent of having patients use them long term, nor do they intend to provide repeat prescriptions. “Opioids are an important drug class that is used to manage short-term pain as well as pain after surgical procedures or trauma,” explains W. Michael Hooten, MD. “At the same time, it’s critical that these medications are prescribed carefully to ensure their safe use by patients.” Studies are lacking on the characteristics associated with the transition from shorter-term to longer-term opioid use, says Dr. Hooten. “When opioids are first prescribed, it’s unclear which patients are more likely to eventually receive repeat prescriptions,” he says. “A better understanding of these characteristics may help guide efforts to optimize opioid use. It could also help us anticipate the potential for inappropriate episodic or long-term use.” Exploring Recent Trends The Consortium to Study Opioid Risks and Trends (CONSORT) is an initiative supported by the National Institute of Drug Abuse that has identified trends and risks associated with long-term opioid therapy for chronic pain. CONSORT classified opioid prescribing patterns as 1) short-term use, 2) episodic use, and 3) long-term use. Dr. Hooten and colleagues had a study published in Mayo Clinic Proceedings that sought to determine how often patients receiving new opioid prescriptions progressed to episodic or long-term opioid use. It also examined associations between patient characteristics and the transition to longer-term use...
Opioid Backlash Threatens Sickle Cell Care
The well-meaning push to curb opioid prescribing could worsen healthcare for sickle cell patients. Clinicians tend to undertreat the substantial pain experienced by many sickle cell patients and treat them as drug addicts. However, research does not support increased risk of addiction in this patient population. Challenging Pain, Few Options A 2008 study in Annals of Internal Medicine revealed a vast undercurrent of chronic pain in sickle cell disease, with 29% of patients reporting pain—which is often severe—nearly every day. On top of that, vaso-occlusive episodes can trigger excruciating pain and life-threatening complications, such as organ damage. These crises prompt most ED visits for sickle cell disease. Hydroxyurea, the one drug approved by the FDA to treat the disease, is used infrequently despite being effective. The drug lessens the frequency of pain crises but does not eliminate them. In any case, opioids remain essential for treating sickle cell pain. Clinical trials testing these agents in sickle cell populations are lacking, but even less is known about possible alternatives. Inaccurate Assumptions of Pain A recent study found that most sickle cell patients delay seeking treatment until their pain nears 9 on a 10-point intensity scale. When they finally go to the ED, they face longer waits for care than others in less pain. In some research, these patients report that healthcare providers sometimes treat them without respect. Indeed, clinicians often wrongly suspect them of exaggerating their pain or abusing drugs. A Patient-Centered Approach to Treating Sickle Cell Pain Treating sickle cell pain starts with assessment, but no laboratory test or physiological marker can measure this pain. Nor can clinicians gauge...
Predicting Prolonged Opioid Use After Surgery
Opioid drug use in patients with chronic pain has been linked to psychological distress and substance abuse. Studies suggest that these factors are often more influential than the intensity of pain patients are experiencing. The determinants of the duration of opioid use after surgery have not been reported in previous research. Furthermore, few analyses have explored the factors that affect ongoing use of opioids after surgery. In Anesthesiology & Analgesia, my colleagues and I had a study published that sought to determine preoperative factors that predict continued use of opioids long after surgery. Preoperative psychological distress and prior substance use was assessed in 109 patients who were undergoing various operations. After surgery, daily use of opioids was measured until patients reported ceasing use of these drugs and having no pain. Three Important Factors According to our results, three preoperative factors were independently related to long-term opioid use: 1. Legitimate prescribed opioid use. 2. Self-perceived risk of addiction. 3. Depressive symptoms. Patients who were using opioids for pain relief before their procedure had a 73% higher likelihood of using these drugs at follow-up. Individuals who rated themselves at increased risk of developing an addiction were more likely to be long-term opioid users. The risk increased 53% for each 1-point increase on a 4-point scale of perceived addiction risk. Patients with symptoms of depression had a 42% higher risk for each 10-point increase on the Beck Depression Inventory scale. The three factors identified in our study were significant regardless of the type of surgery patients underwent. These factors were also better predictors of long-term opioid drug use than the severity of...