Misuse of and dependence on opioids: study of chronic pain patients

Meldon Kahan, Anita Srivastava, Lynn Wilson, Douglas Gourlay, Deana Midmer
Canadian Family Physician Médecin de Famille Canadien 2006, 52 (9): 1081-7

OBJECTIVE: To review the evidence on identifying and managing misuse of and dependence on opioids among primary care patients with chronic pain.

QUALITY OF EVIDENCE: MEDLINE was searched using such terms as "opioid misuse" and "addiction." The few studies on the prevalence of opioid dependence in primary care populations were based on retrospective chart reviews (level II evidence). Most recommendations regarding identification and management of opioid misuse in primary care are based on expert opinion (level III evidence).

MAIN MESSAGE: Physicians should ask all patients receiving opioid therapy about current, past, and family history of addiction. Physicians should take "universal precautions" that include careful prescribing and ongoing vigilance for signs of misuse. Patients suspected of opioid misuse can be treated with a time-limited trial of structured opioid therapy if they are not acquiring opioids from other sources. The trial should consist of daily to weekly dispensing, regular urine testing, and tapering of doses of opioids. If the trial fails or is not indicated, patients should be referred for methadone or buprenorphine treatment.

CONCLUSION: Misuse of and dependence on opioids can be identified and managed successfully in primary care.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"