Opioid analgesics are recognized as a legitimate medical therapy for selected patients with severe chronic pain that does not respond to other therapies. However, opioids are associated with risks for patients and society that include misuse, abuse, diversion, addiction, and overdose deaths. Therapeutic success depends on proper candidate selection, assessment before administering opioid therapy, and close monitoring throughout the course of treatment. Risk assessment and prevention include knowledge of patient factors that may contribute to misuse, abuse, addiction, suicide, and respiratory depression. Risk factors for opioid misuse or addiction include past or current substance abuse, untreated psychiatric disorders, younger age, and social or family environments that encourage misuse. Opioid mortality prevalence is higher in people who are middle aged and have substance abuse and psychiatric comorbidities. Suicides are probably undercounted or frequently misclassified in reports of opioid-related poisoning deaths. Greater understanding and better assessment are needed of the risk associated with suicide risk in patients with pain. Clinical tools and an evolving evidence base are available to assist clinicians with identifying patients whose risk factors put them at risk for adverse outcomes with opioids.
From PRA Health Sciences, Salt Lake City, Utah.
Accepted for publication August 18, 2017.
Funding: Within the past 36 months, L.R.W. has received honorarium or travel expenses or served in an advisory capacity for the following companies: AcelRx Pharmaceuticals, Acura Pharmaceuticals, AstraZeneca, BioDelivery Sciences International, Boehringer Ingelheim, Bristol-Myers Squibb (BMS), Cara Therapeutics, Charleston Labs, Collegium Pharmaceuticals, CVS Caremark, Depomed, Egalet, Grunenthal USA, Inspirion Pharmaceuticals, Insys Therapeutics, Jazz Pharmaceuticals, Kaleo Pharmaceuticals, Mallinckrodt, Marathon Pharmaceuticals, Medtronic, Merck, Nektar Therapeutics, Neura Therapeutik, Nevro Corporation, Orexo Pharmaceuticals, Pfizer, Proove Biosciences, QRx Pharma, Quintiles, Shionogi, Signature Therapeutics, TEVA, Theravance, Trevena, and Zogenix.
The author declares no conflicts of interest.
Reprints will not be available from the author.
Address correspondence to Lynn R. Webster, MD, PRA Health Sciences, 3838 S 700 E, Suite 202, Salt Lake City, UT 84106. Address e-mail to email@example.com.