Balanced opioid Rx in patients at risk for substance abuse

Earl Quijada, MDMay 1, 2012

Trust

Trust

Risk stratify Asses

smen

t

AnalgesiaAberrant behavior

ADL’s

Adver

se ef

fect

UD

S

Risk stratify

Pseudo-addiction

Psychiatric

Social

Passik SD, Portenoy RK. Principles & Practice of Supportive Oncology. Lippincott-Raven, NY: 1998;513-3.

Spec

ific

drug

Addiction

Criminal

1. Root of aberrant behavior

40%

Risk stratify

Pseudo-addiction

Psychiatric

Social

Passik SD, Portenoy RK. Principles & Practice of Supportive Oncology. Lippincott-Raven, NY: 1998;513-3.

Spec

ific

drug

Addiction

Criminal

More Predictive

Selling

Forgery

Stealing

Injecting

Illicit drugs

Risk stratify

Pseudo-addiction

Psychiatric

Social

Passik SD, Portenoy RK. Principles & Practice of Supportive Oncology. Lippincott-Raven, NY: 1998;513-3.

Spec

ific

drug

Addiction

Criminal

Less PredictiveHoarding

Aggressive complaining

Specific drug

Physician hop

Psychic effects

Low Risk Moderate Risk High Risk

Webster LR, Webster RM. Pain Med. 2005;6:432-442.

• No past/current history of substance abuse

• Noncontributory family history of substance abuse

• No major or untreated psychological disorder

• History of treated substance abuse

• Significant family history of substance abuse

• Past/comorbid psychological disorder

• Active substance abuse

• Active addiction

• Major untreated psychological disorder

• Significant risk to self and practitioner

< 1% ~ 45%

2.

Heit HA, Gourlay DL. J Pain Symptom Manage. 2004;27:260-267.

UDS

+ forensic results - compliance results

med bingeingdiversion

insufficient sensitivity

legally rx medOTC

illicit drugs

3.

VAS is useless without a range

4.

30%

Addicted patients demonstrate decrease in function with opioids

5.Physical, family, social, emotional, and spiritual

6.Adverse effects stabilize

except constipation

Sedation, psychic effects

Trust

Risk stratify Asses

smen

t

AnalgesiaAberrant behavior

ADL’s

Adver

se ef

fect

UD

S