Definitions related to the medical use of opioids: Evolution towards universal agreement

Savage, Seddon R.; Joranson, David E.; Covington, Edward C.; Schnoll, Sidney H.; Heit, Howard A.; Gilson, Aaron M.

doi:10.1016/s0885-3924(03)00219-7

Cited by 193 publications

(148 citation statements)

References 41 publications

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“…In the current study, we were not able to determine whether aberrant opiate use was due to true addiction or pseudoaddiction since the latter may only be discerned through clinical intervention and observation (Savage et al 2003). Nevertheless, if pseudoaddiction were present, we would expect that both pain and aberrant opiate use would improve over time whereas pain-specific use would remain stable.…”

Section: Discussionmentioning

confidence: 83%

“…Schieffer et al (2005) in the largest study to date reported that chronic pain patients with a history of substance abuse evidenced higher rates of medication misuse compared to those without such history despite equivalent levels of prescribed opiates and similar self-ratings of medication effectiveness. Lusher et al (2006) found that among patients with sickle cell disease, physiological dependence and illicit drug use were associated with true addiction to opiates (i.e., a primary neurobiological disease characterized by compulsive use despite harm and craving) (Heit 2001;Savage et al 2003) whereas disputes with staff about analgesics were associated with risk of pseudoaddiction (i.e., aberrant behaviors that resolve once pain is adequately treated).…”

Section: Discussionmentioning

confidence: 99%

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Pain, problem drug use history, and aberrant analgesic use behaviors in persons living with HIV

Tsao

Stein²,

Dobalian

2007

Pain

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Little is known about the relationship between pain and aberrant use of prescription analgesics in persons living with HIV. We examined the predictive and concurrent associations among pain, aberrant use of opioids, and problem drug use history in a nationally representative longitudinal sample of 2267 HIV+ persons. Covariance structure analyses tested a conceptual model wherein HIV + patients with a history of problematic drug use (n = 870), compared to those without such history (n = 1397), were hypothesized to report more pain and aberrant opioid use, as well as use of opioids specifically for pain at baseline and 6 and 12 month follow-ups, after controlling for key sociodemographic characteristics. In support of the hypothesized model, patients with a history of problematic drug use reported more pain, and were more likely to report aberrant use of prescription analgesics, as well as use of such medications specifically for pain, compared to patients without such history. We also found a trend toward greater stability of aberrant opioid use over time in problem drug users compared with non-problem users suggesting a persistent pattern of inappropriate medication use in the former group. Our findings suggest that even though HIV+ persons with a history of problematic drug use report on-going patterns of using prescription analgesics specifically for pain, these patients continued to experience persistently higher levels of pain, relative to nonproblem users. Among non-problem users, pain was not linked to aberrant use of opioids, but was linked to the use of such medications specifically for pain.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Pain, problem drug use history, and aberrant analgesic use behaviors in persons living with HIV

Tsao

Stein²,

Dobalian

2007

Pain

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“…Aberrant medication use incorporates a variety of behaviors commonly believed to be associated with opioid medication misuse, abuse, and addiction. 33 Since there is no gold standard for identifying which patients are and which are not abusing their prescription medications, 32 we classified patients into categories of aberrant medication-related behavior by triangulating three perspectives, selfreport via structured interview, physician report, and urine toxicology results. The ADBI is based on positive scores on 1) the self-reported PDUQ, 2) the physician-reported POTQ, and 3) the urine toxicology results.…”

Section: Evaluations Of the Beta Version Of The Soapp-r And Creation mentioning

confidence: 99%

Validation of the Revised Screener and Opioid Assessment for Patients With Pain (SOAPP-R)

Butler

Fernandez

Benoit

et al. 2008

The Journal of Pain

414

334

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The original Screener and Opioid Assessment for Patients with Pain (SOAPP) is a conceptually derived self-report questionnaire designed to predict aberrant medication-related behaviors among chronic pain patients considered for long-term opioid therapy. The purpose of this study was to develop and validate an empirically-derived version of the SOAPP (SOAPP-R) that addresses some limitations of the original SOAPP. In successive steps, items were reduced from an initial pool of 142 to a 97-item beta version. The beta version was administered to 283 chronic pain patients on long-term opioid therapy. Items were evaluated based on data collected at follow-up, including correlation with the Aberrant Drug Behavior Index (ADBI), derived from interview data, physician ratings, and urine toxicology screens. Twenty-four items were retained and comprise the final SOAPP-R. Coefficient α was .88, and receiver operating characteristics (ROC) curve analysis yielded an area under the curve (AUC) of .81 (p < .001). A cutoff score of 18 showed adequate sensitivity (.81) and specificity (.68). The obtained psychometrics, along with the use of a predictive criterion that goes beyond self-report, suggest that the SOAPP-R is an improvement over the original version in screening risk potential for aberrant medication-related behavior among persons with chronic pain. Perspective:There is need for a screener for abuse risk in patients prescribed opioids for pain. This study presents a revised version of the Screener and Opioid Assessment for Patients with Pain (SOAPP-R) that is empirically-derived with good reliability and validity, but is less susceptible to overt deception then the original SOAPP v.1.

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“…39 White et al also conducted subgroup analyses to explore the potential for overlap between dependence and abuse, since dependence is neither a necessary nor sufficient characteristic of abuse or addiction. 40 In these sensitivity analyses, in which the investigators identified nonmutually exclusive subgroups of patients diagnosed either with abuse or with dependence or poisoning, persons in the abuse subgroup had total mean per-patient direct health care costs of $18,388, compared with $2,210 for a matched comparison group. 39 Per-patient costs in the dependence/poisoning group were $16,204, and matched comparison group subjects incurred costs of $2,179.…”

Section: Economic Burden Of Prescription Opioid Misuse and Abusementioning

confidence: 99%

Economic Burden of Prescription Opioid Misuse and Abuse

Strassels¹

2009

JMCP

132

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Pain is an extremely common reason for individuals to seek medical care.1 It is also commonly undertreated in a wide variety of populations.2-8 The consequences of undertreatment of pain can include decreased healing, 9-12 increased costs and resource use, [13][14][15][16][17][18][19] slower return to functioning, 20 and decreased quality of life. [21][22] Prescription opioid analgesics are essential tools in the treatment of moderate to severe pain, yet these drugs are also associated with important problems, including misuse, abuse, and diversion. While appropriate use of opioid analgesics is an important dimension of quality health care, aberrant use may contribute to poorer health outcomes. Thus, an improved understanding of overall costs associated with misuse and abuse of prescription opioid analgesics is relevant for patients, clinicians, payers, employers, and law enforcement officials, all of whom have an interest in ensuring that all medications reach only the people for whom they have been legitimately prescribed. To this end, the purposes of this review were to summarize published, English-language biomedical evidence pertaining to the epidemiology and costs of prescription opioid analgesic misuse and abuse in the United States and to discuss efforts to reduce the burden of opioid abuse and misuse. Economic Burden of Prescription Opioid Misuse and AbuseScott A. Strassels, PharmD, PhD, BCPS S U B J E C T R E V I E W ABSTRACT BACKGROUND: Prescription opioid abuse and its associated costs are a problem in the United States, with significant epidemiologic and economic consequences. The breadth and depth of these consequences are not fully understood at present.

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Definitions related to the medical use of opioids: Evolution towards universal agreement

Cited by 193 publications

References 41 publications

Pain, problem drug use history, and aberrant analgesic use behaviors in persons living with HIV

Pain, problem drug use history, and aberrant analgesic use behaviors in persons living with HIV

Validation of the Revised Screener and Opioid Assessment for Patients With Pain (SOAPP-R)

Economic Burden of Prescription Opioid Misuse and Abuse

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