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Systematic review of opioid dependence in chronic pain

      Opioid use in the treatment of chronic pain is a complex issue, as people with chronic pain may derive both benefit and harm from their use. The former can include reductions in pain intensity, while the latter can include problematic patterns of use or engagement in activities that meet diagnostic criteria for opioid dependence, a substance use disorder. The identification of individuals who are currently using opioids in a problematic way is of great importance and is highly relevant at the present time given the substantial increases over the past decade in rates of morbidity and mortality associated to prescription opioid misuse. At the present time, however, prevalence estimates of opioid dependence vary widely within the literature, from 0% to 48%. This expansive variation is due to a number of factors including issues of study design and setting, as well as variations in methods and definitions used in order to identify opioid dependence. The purpose of the present project was to perform a comprehensive review of the opioid dependence literature in chronic pain, including a method of evaluating quality of reviewed studies to allow for appropriate weighting of individual studies. This poster will present the results of this review, including an estimate of opioid dependence in those who are prescribed opioids for chronic pain, confidence intervals around this estimate, risk factors for misuse, and guidelines for future study which may assist to increase sensitivity and specificity in accurate identification.