RT Journal Article
SR Electronic
T1 Misuse of and dependence on opioids: study of chronic pain patients.
JF Canadian Family Physician
JO Can Fam Physician
FD The College of Family Physicians of Canada
SP 1081
OP 1087
VO 52
IS 9
A1 Meldon Kahan
A1 Anita Srivastava
A1 Lynn Wilson
A1 Douglas Gourlay
A1 Deana Midmer
YR 2006
UL http://www.cfp.ca/content/52/9/1081.abstract
AB 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.