Highlights
- •In a pain rehabilitation program, participants with a history of a nonopioid substance use disorder had 28 times the odds of having an addiction to prescribed medications
- •Each 50-mg increase in daily opioid dose approximately doubled the odds of therapeutic opioid addiction.
- •Opioid dosage can be used as an indicator of addiction with moderate accuracy.
- •The daily opioid dose that should prompt addiction screening is surprisingly low.
Abstract
Limited research examines the risk of therapeutic opioid addiction (TOA) in patients
with chronic noncancer pain. This study examined TOA among 199 patients undergoing
long-term opioid therapy at the time of admission to a pain rehabilitation program.
It was hypothesized that nonopioid substance use disorders and opioid dosage would
predict TOA. Daily mean opioid dose was 132.85 mg ± 175.39. Patients with nonopioid
substance use disorders had 28 times the odds (odds ratio [OR] = 28.58; 95% confidence
interval [CI] = 10.86, 75.27) of having TOA. Each 50-mg increase in opioid dose nearly
doubled the odds of TOA (OR = 1.73; 95% CI = 1.29, 2.32). A 100-mg increase was associated
with a 3-fold increase in odds (OR = 3.00; 95% CI = 1.67, 5.41). Receiver operating
characteristic analysis revealed that opioid dose was a moderately accurate predictor
(area under the curve = .75; 95% CI = .68, .82) of TOA. The sensitivity (.70) and
specificity (.68) of opioid dose in predicting TOA was maximized at 76.10 mg; in addition,
46.00 mg yielded 80% sensitivity in identifying TOA. These results underscore the
importance of obtaining a substance use history prior to prescribing and suggest a
low screening threshold for TOA in patients who use opioids in the absence of improvement
in pain or functional impairment.
Perspective
This article examines TOA in patients with chronic noncancer pain undergoing long-term
opioid therapy. Results suggest that patients should be screened for nonopioid substance
use disorders prior to prescribing. In the absence of improvement in pain or function,
there is a low threshold (∼50 mg daily opioid dose) for addiction screening.
Key words
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Article info
Publication history
Published online: November 08, 2014
Accepted:
October 24,
2014
Received in revised form:
October 14,
2014
Received:
June 27,
2014
Footnotes
Conflict of Interest/Disclosures: No funding was received for this study. All authors report no conflict of interest and have nothing to disclose.
Identification
Copyright
© 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
