Risk of opioid misuse in chronic non-cancer pain in primary care patients - a cross sectional study

Abstract

BackgroundEfforts to improve treatment of pain using opioids have to adequately take into account their therapeutic shortcomings which involve addictiveness. While there are no signs of an “opioid epidemic” in Germany similar to that in the US, there is little data on the prevalence of prescription opioid misuse and addiction. Therefore, our objective was to screen primary care patients on long-term opioid therapy for signs of misuse of prescription opioids.MethodsWe recruited 15 GPs practices and asked all patients on long-term opioid therapy (> 6 months) to fill out a questionnaire including the “Current Opioid Misuse Measure” (COMM®), a self-report questionnaire. Patients with a malignant disease were excluded.ResultsN = 91 patients participated in the study (response rate: 75.2%). A third (31.5%) showed a positive COMM® - Score which represents a high risk of aberrant drug behaviour. A positive COMM® - Score showed a statistically significant correlation with a lifetime diagnosis of depression and neck pain.ConclusionsWhile Germany does not face an “opioid eoidemic”, addictiveness of opioids should be considered when using them in chronic non-tumor pain. In our study population, almost every third patient was at risk and should therefore be followed up closely. Co-prevalence of depression is a significant issue and should always be screened for in patients with chronic pain, especially thus with aberrant drug behaviour.

Rate of opioid use disorder in adults who received prescription opioid pain therapy—A secondary data analysis

“…Still, there is little data with a focus on diagnosing addiction or misuse in patients receiving prescription opioids. Two recent, cross-sectional trials in Germany showed that a significant proportion of ambulatory patients with CNCP and long-term opioid therapy (LTOT) were at high risk of opioid misuse (31.5%) or had been diagnosed with prescription opioid use disorder (pOUD) (26.5%), yet both trials lacked in size and generalizability [10,11]. Additional analysis from larger datasets would be useful to assess the situation in Germany.…”

Pharmacogenetics and prediction of adverse events in prescription opioid use disorder patients

“…This result is important because, while Europe does not face an "opioid epidemic," addiction to opioids should be considered when using them in CNCP and should therefore be closely monitored. 6 The OPRM1 gene could therefore help us to evaluate the most frequent opioid AEs: gastrointestinal disorders.…”

“…The patients reported a total of 1659 AEs in a total of 359 visits (median of 7 [4][5][6][7][8][9] EAs/visit). The most frequent AEs classified by system were psychiatric (21%) and gastrointestinal disorders (20%; Figure 3A).…”

“…In the baseline visit, the total number of AEs varies significantly among OPRM1 genotypes as shown in Figure 4. The total number of AEs was higher in OPRM1 AA carriers who reported almost two more AEs than AG/GG patients (7 [5][6][7][8][9][10][11] vs 5 [3][4][5][6][7][8][9], P = 0.046). In the overdominant model, COMT-AA/GG genotypes showed a significantly higher number of AEs/patient (8 [6][7][8][9][10][11], P = 0.026).…”

“…5 A meta-analysis on the misuse of medication in the EU revealed that prescribed opioids were among the main groups concerned; data on mortality directly linked to their consumption in Europe are still, however, unavailable. 6 The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) now includes the term opioid use disorder and has established its diagnostic criteria. 7 Once presented, an individualized opioid tapering or deprescription treatment plan should be applied, together with general recommendations that include monitoring, opioid rotation, discontinuation of therapy and prevention of suspected opioid adverse drug reactions (ADRs) or adverse events (AEs).…”