Strategies to Identify Patient Risks of Prescription Opioid Addiction When Initiating Opioids for Pain

Files in This Item:
File Description SizeFormat 
ORT_Mar15_clean.pdf255.02 kBAdobe PDFDownload
Title: Strategies to Identify Patient Risks of Prescription Opioid Addiction When Initiating Opioids for Pain
Authors: Klimas, JanGorfinkel, LaurenFairbairn, Nadiaet al.
Permanent link: http://hdl.handle.net/10197/10570
Date: 3-May-2019
Online since: 2019-05-21T10:28:44Z
Abstract: 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.
Funding Details: European Commission
metadata.dc.description.othersponsorship: Canadian Institutes of Health Research - Canada Research Chairs Program
Michael Smith Foundation for Health Research
Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Health Care System
Type of material: Journal Article
Publisher: American Medical Association (AMA)
Journal: JAMA Network Open
Volume: 2
Issue: 5
Copyright (published version): 2019 the Authors
Keywords: Opioid use disorderRisk assessmentPainSystematic review
DOI: 10.1001/jamanetworkopen.2019.3365
Language: en
Status of Item: Peer reviewed
Appears in Collections:Medicine Research Collection

Show full item record

SCOPUSTM   
Citations 50

2
Last Week
1
Last month
checked on Nov 10, 2019

Page view(s)

172
checked on Nov 12, 2019

Download(s)

69
checked on Nov 12, 2019

Google ScholarTM

Check

Altmetric


This item is available under the Attribution-NonCommercial-NoDerivs 3.0 Ireland. No item may be reproduced for commercial purposes. For other possible restrictions on use please refer to the publisher's URL where this is made available, or to notes contained in the item itself. Other terms may apply.