Opioid Analgesics Less Addictive Than Feared?

September 6, 2013 – 11:04

Opioid Analgesics Less Addictive Than Feared?

Addiction Fears There have been ongoing concerns among healthcare providers and regulators about the addictive potential of opioid analgesics during pain treatment. Some claim patients prescribed these medications readily become addicted to them, while others believe that therapy-induced, or iatrogenic, addiction is relatively uncommon. Recently, the most complete systematic review of research evidence to date attempted to put the rumors to rest on this controversial subject.

Silvia Minozzi, MD and colleagues — from the Department of Epidemiology, Lazio Regional Health Service, Cochrane Drugs and Alcohol Group, Rome, Italy — conducted a comprehensive systematic review to assess the incidence and prevalence of dependence syndrome (ie, addiction) associated with opioid therapy for pain relief in adults with and without a previous history of substance abuse [Minozzi et al. 2012]. Their literature search included Medline, Embase, CINHAL and the Cochrane Library up to January 2011.

Systematic reviews and primary studies were included if they reported data about the incidence or prevalence of opioid addiction in patients receiving opioid-class drugs for treatment of acute or chronic pain due to any physical condition, whether cancer- and noncancer-related. Any type of clinical research design qualified, as long as sufficient data were available for assessment. Of 2, 871 potentially relevant studies identified (excluding duplicate studies), data were extracted from 17 investigations that qualified for inclusion, involving a total of 88, 235 patients.

Minozzi et al. found that the incidence of addiction reported across the various studies ranged from 0% to 24% (median 0.5%), while prevalence ranged from 0% to 31% (median 4.5%). However, there was a great amount of variation among the studies, or heterogeneity, in terms of design, definitions of addiction, data collection, and other factors, so a data meta-analysis could not be conducted. Overall, the researchers rated the evidence as being of very low quality.

The researchers observe that fears of patients developing opioid addiction are greatest when prescribing opioids to treat chronic noncancer pain conditions, as both the course of treatment and the life expectancy of patients are often expected to be long — allowing time for addiction to develop. However, despite the many limitations encountered in their review, the authors conclude that, “The available evidence suggests that opioid analgesics for chronic pain conditions are not associated with a major risk for developing dependence [addiction].”

Source: updates.pain-topics.org

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