Strategy for Prescribing Opioids to Patients with Potential Addiction

Opioid addiction is a serious problem that a subset of patients prescribed opioids for pain could face; however, the issue presents an even more slippery slope for those with chronic pain due to the long-term need for the drugs.

Seven addiction psychiatry fellows (APF) from Beth Israel Medical Center in NYC may have found a valuable way to evaluate patients with pain who are also at risk for opioid misuse. The findings from their study were presented at the 34^th Annual American Pain Society Scientific Meeting in Palm Springs, CA. While individuals with short-term pain are weaned off of the drugs, this does not happen for those with long-term pain.

“Unfortunately, there are few resources for those patients who have chronic pain and a history of prescription opioid misuse and patients might opt to obtain the medications illegally to control their pain,” the study explained.

The 202 participants (122 male, average age of 52) suffered from a range of conditions — including 42% with more than one diagnosis and 2 patients without a diagnosis:

• 55% with spinal disorders such as neck and back pain (110 patients)
• 22% with musculoskeletal or joint pain (44 patients)
• 5% with cancer-related pain (10 patients)
• 2% with fibromyalgia or chronic fatigue syndrome (5 patients)
• 2% with migraine or chronic headache (4 patients)
• 1% with rheumatoid arthritis (2 patients)
• 1% with diabetic neuropathy (2 patients)
• 16% with other (33 patients)

The fellows assessed the patients, referred by pain practitioners, during a single half-day session. The evaluation addressed multiple topics, including the reason for the referral and patients’ characteristics. This helped the APFs determine which patients should continue with their prescriptions or stop due to their perceived risk for misuse.

The team noted that 48 of the patients were on methadone or the Methadone Maintenance Treatment Program (MMTP). The data revealed that 128 patients had abnormal toxicology results and another 128 were considered at high risk.

Only 84 patients (42%) were recommended to continue with their treatments — including 51 non-opioids (25%), 17 methadone (8%), 13 discharge (6%), 9 psychiatric treatment (4%), and 4 opioids (2%). Furthermore, 60 patients were recommended for rehab or detox but 37 refused.

“The APF fellows rated the experience as highly valuable,” the report said. “This strategy could be valuable tool in academic centers with fellowships in addiction psychiatry.”