Moving Beyond Misuse and Diversion: The Urgent Need to Consider the Role of Iatrogenic Addiction in the Current Opioid Epidemic

Abstract

An epidemic of drug overdose deaths has led to calls for programs and policies to limit misuse and diversion of opioid medications. Any parallel call to consider the risk of iatrogenic addiction when treating pain has been muted in comparison. We have moved beyond questions of nonmedical use, abuse, and diversion to highlight the role of prescription opioids in causing addiction even when prescribed and used appropriately. Unfortunately, current evidence is insufficient, and a rapid expansion of longitudinal research is urgently needed to guide clinicians in balancing the need for opioids with the risk of adverse consequences. Meanwhile, medical education should place greater emphasis on the abuse liability of prescription opioids, and providers should endeavor to attenuate risk when possible.

Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century

“…The increased availability of opioid prescriptions for pain that began in the late 1990s has been widely noted, as has the associated mortality (14,(20)(21)(22). The CDC estimates that for each prescription painkiller death in 2008, there were 10 treatment admissions for abuse, 32 emergency department visits for misuse or abuse, 130 people who were abusers or dependent, and 825 nonmedical users (23).…”

The Efficacy of Crotalidae Polyvalent Immune Fab (Ovine) Antivenom Versus Placebo Plus Optional Rescue Therapy on Recovery From Copperhead Snake Envenomation: A Randomized, Double-Blind, Placebo-Controlled, Clinical Trial

“…Because prescribing opioid analgesia carries some risk of iatrogenic opioid abuse disorder and ED opioid prescriptions may contribute to the development of addiction, the role of FabAV in decreasing opioid requirements during recovery is intriguing. [50][51][52][53][54] Because these findings are exploratory, future research is necessary to determine the potential effect of FabAV treatment on long-term opioid use after envenomation.…”

The Toxicologist as Educator: Addressing Pain Management in the Midst of an Opioid Epidemic

“…Incorporate a discussion on the studies revealing an increased risk of long-term opioid use after administration in the acute setting [4][5][6]. Educators can also provide literature introducing the concept of Biatrogenic addiction^ [7][8][9][10][11]. Education: remind the trainee that part of treating pain properly involves patient education, including explaining to patients why particular medications are selected for them, the risks and side effects of the medication, and resources available to patients who become dependent on a prescribed medication [12].…”

“…As the opioid epidemic continues to gain attention in the medical world and mainstream press, medical educators are moving to standardize the education of providers in appropriate pain management, safer prescribing patterns, and the use of prescription monitoring databases [7][8][9][10][13][14][15][16][17]. The toxicology rotation holds great potential as a transformative experience for the medical trainee on this topic, and toxicologists are uniquely poised to seamlessly integrate this training into daily didactics and case discussions.…”