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      Recomendaciones para la prescripción segura de opioides en pacientes con historia o riesgo de abuso Translated title: Recommendations for the safe prescription of opioids in patients with a history or risk of abuse

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          Abstract

          RESUMEN El dolor crónico es uno de los problemas médicos más frecuentes y su alivio debe ser una meta terapéutica prioritaria. Los analgésicos opioides constituyen la piedra angular. Sin embargo, en dolor crónico y el potencial adictivo de estos fármacos, así como su uso indebido y el preocupante aumento de muertes por sobredosis en algunos países como EE. UU., han obligado a las autoridades de salud a implementar estrategias coordinadas para promover la prescripción segura y responsable para mitigar los riesgos en el uso de opioides.

          Translated abstract

          ABSTRACT Chronic pain is one of the most frequent medical problems and its relief should be a priority therapeutic goal; Opioid analgesics constitute the cornerstone, however, in chronic pain and the addictive potential of these drugs, as well as their misuse and the worrying increase in overdose deaths in some countries such as the US, have forced health authorities to implement coordinated strategies to promote safe and responsible prescribing, to mitigate risks in the use of opioids.

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          The Neurobiology of Opioid Dependence: Implications for Treatment

          Thomas R. Kosten, Tony George (2002)
          Opioid tolerance, dependence, and addiction are all manifestations of brain changes resulting from chronic opioid abuse. The opioid abuser’s struggle for recovery is in great part a struggle to overcome the effects of these changes. Medications such as methadone, LAAM, buprenorphine, and naltrexone act on the same brain structures and processes as addictive opioids, but with protective or normalizing effects. Despite the effectiveness of medications, they must be used in conjunction with appropriate psychosocial treatments.
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            Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system.

            Walter Stewart, Jing-Dong J. Han, Margaret Rukstalis … (2010)
            Our study sought to assess the prevalence of and risk factors for opioid drug dependence among out-patients on long-term opioid therapy in a large health-care system. Using electronic health records, we identified out-patients receiving 4+ physician orders for opioid therapy in the past 12 months for non-cancer pain within a large US health-care system. We completed diagnostic interviews with 705 of these patients to identify opioid use disorders and assess risk factors. Preliminary analyses suggested that current opioid dependence might be as high as 26% [95% confidence interval (CI) = 22.0-29.9] among the patients studied. Logistic regressions indicated that current dependence was associated with variables often in the medical record, including age <65 [odds ratio (OR) = 2.33, P = 0.001], opioid abuse history (OR = 3.81, P < 0.001), high dependence severity (OR = 1.85, P = 0.001), major depression (OR = 1.29, P = 0.022) and psychotropic medication use (OR = 1.73, P = 0.006). Four variables combined (age, depression, psychotropic medications and pain impairment) predicted increased risk for current dependence, compared to those without these factors (OR = 8.01, P < 0.001). Knowing that the patient also had a history of severe dependence and opioid abuse increased this risk substantially (OR = 56.36, P < 0.001). Opioid misuse and dependence among prescription opioid patients in the United States may be higher than expected. A small number of factors, many documented in the medical record, predicted opioid dependence among the out-patients studied. These preliminary findings should be useful in future research efforts. © 2010 The Authors, Addiction © 2010 Society for the Study of Addiction.
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              Prescription opioid abuse in chronic pain: a review of opioid abuse predictors and strategies to curb opioid abuse.

              Adrian Smith, Laxmaiah Manchikanti, Nalini Sehgal (2012)
              Both chronic pain and prescription opioid abuse are prevalent and continue to exact a heavy toll on patients, physicians, and society. Individuals with chronic pain and co-occurring substance use disorders and/or mental health disorders, are at a higher risk for misuse of prescribed opioids. Opioid abuse and misuse occurs for a variety of reasons, including self medication, use for reward, compulsive use because of addiction, and diversion for profit. Treatment approaches that balance treating chronic pain while minimizing risks for opioid abuse, misuse, and diversion are much needed. The use of chronic opioid therapy for chronic noncancer pain has increased dramatically in the past 2 decades in conjunction with a marked increase in the abuse of prescribed opioids and accidental opioid overdoses. Consequently, a validated screening instrument that provides an effective and rational method of selecting patients for opioid therapy, predicting risk, and identifying problems once they arise could be of enormous benefit. Such an instrument could potentially curb the risk of iatrogenic addiction. Although several screening instruments and strategies have been introduced in the past decade, there is no single test or instrument that can reliably and accurately predict patients who are not suitable for opioid therapy or identify those who need increased vigilance or monitoring during therapy. At present screening for opioid abuse includes assessment of premorbid and comorbid substance abuse; assessment of aberrant drug-related behaviors; risk factor stratification; and utilization of opioid screening tools. Multiple opioid assessment screening tools and instruments have been developed by various authors. In addition, urine drug testing, monitoring of prescribing practices, prescription monitoring programs, opioid treatment agreements, and utilization of universal precautions are essential. Presently, a combination of strategies is recommended to stratify risk, identify and understand aberrant drug related behaviors, and tailor treatments accordingly. This manuscript will review the current state of knowledge regarding the growing problem of opioid abuse and misuse; known risk factors; and methods of predicting, assessing, monitoring, and addressing opioid abuse and misuse in patients with chronic noncancer pain.
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                Author and article information

                Journal
                Journal ID (publisher-id): dolor
                Title: Revista de la Sociedad Española del Dolor
                Abbreviated Title: Rev. Soc. Esp. Dolor
                Publisher: Inspira Network Group, S.L (Madrid, Madrid, Spain )
                ISSN (Print): 1134-8046
                Publication date (Print and electronic): December 2021
                Volume: 28
                Issue: 6
                Pages: 343-349
                Affiliations
                [3] Bucaramanga Santander orgnameUniversidad Industrial de Santander Colombia
                [4] Bucaramanga orgnameHospital Internacional de Colombia orgdiv1Servicio de Dolor y Cuidado Paliativo Colombia
                [1] Bucaramanga Santander orgnameUniversidad Industrial de Santander orgdiv1Hospital Internacional de Colombia y Hospital Universitario de Santander orgdiv2Servicio de Dolor y Cuidado Paliativo Colombia
                [2] Bogotá orgnameUniversidad de la Sabana orgdiv1Instituto Nacional de Cancerología Colombia
                Article
                Publisher ID: S1134-80462021000700343 Publisher ID: S1134-8046(21)02800600343
                DOI: 10.20986/resed.2022.3935/2021
                SO-VID: 35501569-56fa-4f24-9006-bbc63dd1c336
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                Date received : 08 August 2021
                Date accepted : 21 February 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 28, Pages: 7
                Product

                SciELO Spain

                Categories
                Subject: Revisión

                Keywords: Opioids,abuse,risk,Opioides,abuso,riesgo
                Data availability:
                Keywords: Opioids, abuse, risk, Opioides, abuso, riesgo

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