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Strategies to Identify Patient Risks of Prescription Opioid Addiction When Initiating Opioids for Pain: A Systematic Review
Open accessAbstract
Importance: Although prescription opioid use disorder is associated with substantial harms, strategies to identify patients with pain among whom prescription opioids can be safely prescribed have not been systematically reviewed. Objective: To review the evidence examining factors associated with opioid addiction and screening tools for identifying adult patients at high vs low risk of developing symptoms of prescription opioid addiction when initiating prescription opioids for pain. Data Sources: MEDLINE and Embase (January 1946 to November 2018) were searched for articles investigating risks of prescription opioid addiction. Study Selection: Original studies that were included compared symptoms, signs, risk factors, and screening tools among patients who developed prescription opioid addiction and those who did not. Data Extraction and Synthesis: Two investigators independently assessed quality to exclude biased or unreliable study designs and extracted data from higher quality studies. The Preferred Reporting Items for Systematic Reviews and Meta-analyses of Diagnostic Accuracy Studies (PRISMA-DTA) reporting guideline was followed. Main Outcomes and Measures: Likelihood ratios (LRs) for risk factors and screening tools were calculated. Results: Of 1287 identified studies, 6 high-quality studies were included in the qualitative synthesis and 4 were included in the quantitative synthesis. The 4 high-quality studies included in the quantitative synthesis were all retrospective studies including a total of 2 888 346 patients with 4470 cases that met the authors' definitions of prescription opioid addiction. A history of opioid use disorder (LR range, 17-22) or other substance use disorder (LR range, 4.2-17), certain mental health diagnoses (eg, personality disorder: LR, 27; 95% CI, 18-41), and concomitant prescription of certain psychiatric medications (eg, atypical antipsychotics: LR, 17; 95% CI, 15-18) appeared useful for identifying patients at high risk of opioid addiction. Among individual findings, only the absence of a mood disorder (negative LR, 0.50; 95% CI, 0.45-0.52) was associated with a lower risk of opioid addiction. Despite their widespread use, most screening tools involving combinations of questions were based on low-quality studies or, when diagnostic performance was assessed among high-quality studies, demonstrated poor performance in helping to identify patients at high vs low risk. Conclusions and Relevance: While a history of substance use disorder, certain mental health diagnoses, and concomitant prescription of certain psychiatric medications appeared useful for identifying patients at higher risk, few quality studies were available and no symptoms, signs, or screening tools were particularly useful for identifying those at lower risk.
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“Use of prescribed opioids for pain can lead to opioid addiction [61].”
From Substance and Behavioral Addictions among American Indian and Alaska Native Populations (2022) · cites this paper as [61]
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“The continued use of prescription opioids among adolescents may be an example of maladaptive coping (Hendy et al., 2018; Klimas et al., 2019), which can be explained by the Lazarus and Folkman as a way of coping that was beneficial at one point and time but became maladaptive.”
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Prevalence and Profile of Tapentadol Use in Patients Visiting a Drug De-addiction Center in Kashmir
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“A history of a substance use disorder (SUD) and certain mental health diagnoses, such as psychotic disorders, personality disorders and anxiety disorders, are associated with an increased risk of developing OUD.6,13 Additionally, indicators of economic disadvantage have also been associated with the development of OUD…”
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Metadata
- Authors
- Klimas, J., Gorfinkel, L., Fairbairn, N., Amato, L., Ahamad, K., Nolan, S., Simel, D. L., & Wood, E.
- Affiliations
- School of Medicine, University College Dublin, Health Sciences Centre, Belfield, Dublin, Ireland
- Columbia University (US)
- University of British Columbia (CA)
- Regione Lazio (IT)
- Duke University (US)
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2019-05-03
- Volume
- 2
- Issue
- 5
- Pages
- e193365
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC6503484
- OpenAlex
- W2942730080
- Cited by
- 162
- References
- 38
- Citations by year
- 2026: 12 · 2025: 17 · 2024: 21 · 2023: 20 · 2022: 33 · 2021: 33 · 2020: 17 · 2019: 8
- FWCI
- 3.72
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JAMA Network Open (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Repository UCD (University College Dublin) (submittedVersion, cc-by-nc-nd)
- Arrow@dit (Dublin Institute of Technology) (submittedVersion, cc-by-nc-nd)
- Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion)
- Funders
- U.S. Department of Veterans Affairs (CIN 13–410)
- Bond University
- Michael Smith Health Research BC
- European Commission (701698)
- Canada Research Chairs (Tier1)
- University of British Columbia
- Canadian Institutes of Health Research (397968)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- prescription opioid use disorder, opioid addiction risk, pain management, opioid initiation, risk screening tool, risk factors, substance use disorders, mental health diagnoses, personality disorders, atypical antipsychotics, psychiatric medication, mood disorders, diagnostic accuracy, likelihood ratios
- MeSH terms
- Analgesics, Opioid, Female, Humans, Male, Opioid-Related Disorders, Practice Patterns, Physicians', Retrospective Studies, Risk Factors, Risk Assessment, Mood Disorders, Chronic Pain
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