REVIEW - What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors?

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Pain Medicine

Volume 9 Issue 4, Pages 444 - 459

Published Online: 3 Oct 2007

Review Article

What Percentage of Chronic Nonmalignant Pain Patients Exposed to

Chronic Opioid Analgesic Therapy Develop Abuse/Addiction and/or

Aberrant Drug-Related Behaviors? A Structured Evidence-Based Review

A. Fishbain, MD, FAPA,*†‡§¶** Brandly Cole, PsyD, ¶††

, PhD,*‡ Hubert L. Rosomoff, MD, DMedSc, FAAPM,*†§¶†† and R.

Steele Rosomoff, BSN, MBA*†§¶††

* School of Medicine at the University of Miami, Departments of

† Neurological Surgery, ‡ Psychiatry and § Anesthesiology,

**Department of Psychiatry, Miami VA Medical Center, Miami, Florida;

¶ The Rosomoff Comprehensive Pain Center, †† at Gardens,

Miami, Florida, USA

ABSTRACT

Design. This is a structured evidence-based review of all available

studies on the development of abuse/addiction and aberrant

drug-related behaviors (ADRBs) in chronic pain patients (CPPs) with

nonmalignant pain on exposure to chronic opioid analgesic therapy

(COAT).

Objectives. To determine what percentage of CPPs develop

abuse/addiction and/or ADRBs on COAT exposure.

Method. Computer and manual literature searches yielded 79 references

that addressed this area of study. Twelve of the studies were excluded

from detailed review based on exclusion criteria important to this

area. Sixty-seven studies were reviewed in detail and sorted according

to whether they reported percentages of CPPs developing

abuse/addiction or developing ADRBs, or percentages diagnosed with

alcohol/illicit drug use as determined by urine toxicology. Study

characteristics were abstracted into tabular form, and each report was

characterized according to the type of study it represented based on

the Agency for Health Care Policy and Research Guidelines. Each study

was independently evaluated by two raters according to 12 quality

criteria and a quality score calculated. Studies were not utilized in

the calculations unless their quality score (utilizing both raters)

was greater than 65%. Within each of the above study groupings, the

total number of CPPs exposed to opioids on COAT treatment was

calculated. Similarly, the total number of CPPs in each grouping

demonstrating abuse/addiction, ADRBs, or alcohol/illicit drug use was

also calculated. Finally, a percentage for each of these behaviors was

calculated in each grouping, utilizing the total number of CPPs

exposed to opioids in each grouping.

Results. All 67 reports had quality scores greater than 65%. For the

abuse/addiction grouping there were 24 studies with 2,507 CPPs exposed

for a calculated abuse/addiction rate of 3.27%. Within this grouping

for those studies that had preselected CPPs for COAT exposure for no

previous or current history of abuse/addiction, the percentage of

abuse/addiction was calculated at 0.19%. For the ADRB grouping, there

were 17 studies with 2,466 CPPs exposed and a calculated ADRB rate of

11.5%. Within this grouping for preselected CPPs (as above), the

percentage of ADRBs was calculated at 0.59%. In the urine toxicology

grouping, there were five studies (15,442 CPPs exposed). Here, 20.4%

of the CPPs had no prescribed opioid in urine and/or a nonprescribed

opioid in urine. For five studies (1,965 CPPs exposed), illicit drugs

were found in 14.5%.

Conclusion. The results of this evidence-based structured review

indicate that COAT exposure will lead to abuse/addiction in a small

percentage of CPPs, but a larger percentage will demonstrate ADRBs and

illicit drug use. These percentages appear to be much less if CPPs are

preselected for the absence of a current or past history of

alcohol/illicit drug use or abuse/addiction.

http://www3.interscience.wiley.com/journal/120089377/abstract?CRETRY=1 & SRETRY=0

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