With opioid abuse and misuse so prevalent today, it is important to understand the scale of the issue and be aware that certain factors might put you or someone you know at risk for developing opioid addiction, abuse, harm or misuse.
The Growing Concern for Opioid Related Risks
There is increasing concern for opioid related risks such as addiction, abuse, harm or misuse, as reported statistics show this is an expansive problem. As many as 1 in 4 people who receive prescription opioids long term for noncancerous pain in primary care settings struggle with addiction. Even in pain clinic settings, the prevalence of addiction has been reported to range from 2-14% and every day over 1,000 people are treated in emergency departments for misusing prescription opioids.
Not only are these prevalence rates shocking, but the price tag is too. A recent Centers for Disease Control and Prevention (CDC) publication reported the yearly cost of prescription opioid abuse, dependence (i.e., opioid use disorder) and misuse of prescription opioids as $55.7 billion.
Opioid Use Disorder Defined
The diagnosis term “opioid use disorder” came about when the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) took the terms opioid abuse and opioid dependence and replaced them with one diagnosis term - called opioid use disorder (OUD). OUD has also been referred to as “abuse or dependence” and “addiction” in the literature, and is different from tolerance (diminished response to a drug with repeated use) and physical dependence (adaptation to a drug that produces symptoms of withdrawal when the drug is stopped), both of which can exist without a diagnosed disorder.
In order to be diagnosed with OUD, specific criteria need to be met, such as unsuccessful efforts to cut down or control use, use resulting in social problems and a failure to fulfill major role obligations at work, school, or home. Although clinical criteria have varied over time, opioid use disorder can be considered a problematic pattern of opioid use leading to clinically significant impairment or distress.
Benefits and Risks Assessments
While some patients may benefit from opioid therapy, there has been an increased push for ongoing evaluation of the balance between benefits and risks for each individual prescribed an opioid regimen. Long-term opioid therapy can cause harms ranging in severity from constipation to OUD to overdose death. Certain factors can increase these risks, and the CDC recommends assessing factors that could increase risk to reduce potential harms.
When it comes to risk assessment for opioids and the available instruments or tools specifically, there remains a debate regarding the accuracy of detecting current misuse and abuse of prescription opioids with risk assessment tools. No one tool will be 100 percent accurate for assessing future risk, however, when taken in context as a data point within a whole picture, they can provide important information for consideration.
Risk assessment instruments have been designed to assess such risk as opioid misuse prior to starting long-term opioid therapy (such as the Opioid Risk Tool, and the Diagnosis, Intractability, Risk and Efficacy Score), signs of misuse in people currently using opioids (such as Current Opioid Misuse Measure), and general substance abuse as well such as the Drug Abuse Screening Test.
Even without the use of a specific risk assessment tool, some experts have suggested that risk factors for opioid misuse include: personal history of a substance use disorder (including tobacco use disorder), family history of a substance use disorder, and mental health disorder (including depression and anxiety).
Additionally, people potentially at greater risk for harm from opioids, include people with sleep-disordered breathing (such as sleep apnea) or other underlying respiratory conditions, pregnancy, concurrent benzodiazepine use, and kidney or liver insufficiency. There are also increased risks for OUD, respiratory depression, and death at higher opioid dosages.
What You Can Do
To reduce the chances of opioid related harms, you should stay informed and know your options. There are several pain management tools that are not opioids and there may be ways to manage your pain that don’t involve prescription opioids and may have a better risk versus benefit profile for you.
If prescribed an opioid regimen, it is important to take opioids only for as long as your doctor or nurse prescribes them and only at the dose he or she recommends. Never take opioids that were not prescribed to you, keep your medications in a safe storage place and tell your doctor or nurse if the opioids seem to stop working. If the problem you were taking the opioids for gets better, safely dispose of any leftover opioids. Do not keep old opioids around the house.
Although there are perceptions that opioid therapy for chronic pain is less expensive than more time-intensive nonpharmacologic management approaches, it is important to take into account the many potential costs of opioids, such as OUD, as well. Staying informed and assessing the balance of risks verses benefits of opioid therapy options can help lead to an informed pain treatment plan.
