Johannes Just1, Martin Mücke, Markus Bleckwenn. 1. Institute of General Practice and Family Medicine, Universität Bonn, Department of Palliative Medicine, University Hospital Bonn, Center for Rare Diseases, University Hospital Bonn.
Abstract
BACKGROUND: The incidence of initial prescriptions of opioids for chronic non-cancer pain rose by 37% in Germany from 2000 to 2010. Prescribing practice does not always conform with the recommendations of current guidelines. In the USA, 8-12% of patients with chronic non-cancer pain are opioid-dependent. METHODS: This review is based on publications retrieved by a selective PubMed search and on the German S3 guideline on the long-term use of opioids in non-cancer pain. RESULTS: Patients must be informed and counseled about the effects and risks of opioids before these drugs are prescribed. All opioid prescriptions for patients with chronic non-cancer pain should be regularly reviewed. The risk of abuse is high in young adults (odds ratio [OR] = 6.74) and in those with a history of substance abuse (OR = 2.34). Any unusual medication-related behavior, e.g., loss of prescriptions or increasing the dose without prior discussion with the physician, calls for further assessment by the physician in conversation with the patient. Urine testing for drugs and their metabolites is helpful as well. The goal of treatment of opioid abuse is opioid abstinence by gradual reduction of the dose. If this is not possible on an outpatient basis, hospitalization for drug withdrawal or substitution-based addiction therapy can be offered. CONCLUSION: Physicians who know the indications and risks of opioid therapy and the typical behavior of drug-dependent patients will be better able to identify patients at risk and to prevent dependence. Studies on the prevalence of opioid abuse and dependence in German patients with chronic pain can help provide better estimates of the current extent and implications of this problem in Germany.
BACKGROUND: The incidence of initial prescriptions of opioids for chronic non-cancer pain rose by 37% in Germany from 2000 to 2010. Prescribing practice does not always conform with the recommendations of current guidelines. In the USA, 8-12% of patients with chronic non-cancer pain are opioid-dependent. METHODS: This review is based on publications retrieved by a selective PubMed search and on the German S3 guideline on the long-term use of opioids in non-cancer pain. RESULTS:Patients must be informed and counseled about the effects and risks of opioids before these drugs are prescribed. All opioid prescriptions for patients with chronic non-cancer pain should be regularly reviewed. The risk of abuse is high in young adults (odds ratio [OR] = 6.74) and in those with a history of substance abuse (OR = 2.34). Any unusual medication-related behavior, e.g., loss of prescriptions or increasing the dose without prior discussion with the physician, calls for further assessment by the physician in conversation with the patient. Urine testing for drugs and their metabolites is helpful as well. The goal of treatment of opioid abuse is opioid abstinence by gradual reduction of the dose. If this is not possible on an outpatient basis, hospitalization for drug withdrawal or substitution-based addiction therapy can be offered. CONCLUSION: Physicians who know the indications and risks of opioid therapy and the typical behavior of drug-dependent patients will be better able to identify patients at risk and to prevent dependence. Studies on the prevalence of opioid abuse and dependence in German patients with chronic pain can help provide better estimates of the current extent and implications of this problem in Germany.
Authors: Gary M Franklin; Jaymie Mai; Judith Turner; Mark Sullivan; Thomas Wickizer; Deborah Fulton-Kehoe Journal: Am J Ind Med Date: 2011-12-27 Impact factor: 2.214
Authors: Roger D Weiss; Jennifer Sharpe Potter; David A Fiellin; Marilyn Byrne; Hilary S Connery; William Dickinson; John Gardin; Margaret L Griffin; Marc N Gourevitch; Deborah L Haller; Albert L Hasson; Zhen Huang; Petra Jacobs; Andrzej S Kosinski; Robert Lindblad; Elinore F McCance-Katz; Scott E Provost; Jeffrey Selzer; Eugene C Somoza; Susan C Sonne; Walter Ling Journal: Arch Gen Psychiatry Date: 2011-11-07
Authors: Howard G Birnbaum; Alan G White; Matt Schiller; Tracy Waldman; Jody M Cleveland; Carl L Roland Journal: Pain Med Date: 2011-03-10 Impact factor: 3.750
Authors: Mark J Edlund; Bradley C Martin; Ming-Yu Fan; Andrea Devries; Jennifer B Braden; Mark D Sullivan Journal: Drug Alcohol Depend Date: 2010-07-14 Impact factor: 4.492
Authors: Jeffrey D Rome; Cynthia O Townsend; Barbara K Bruce; Christopher D Sletten; Connie A Luedtke; John E Hodgson Journal: Mayo Clin Proc Date: 2004-06 Impact factor: 7.616
Authors: Johannes Maximilian Just; Fabian Schwerbrock; Markus Bleckwenn; Rieke Schnakenberg; Klaus Weckbecker Journal: BMJ Open Date: 2019-04-03 Impact factor: 2.692
Authors: Johannes M Just; Markus Bleckwenn; Rieke Schnakenberg; Philipp Skatulla; Klaus Weckbecker Journal: Subst Abuse Treat Prev Policy Date: 2016-12-09