Question 18

Current research suggests that about 1 in 10 patients with chronic pain manifest behavior consistent with opioid use disorder. Of chronic pain patients, 21-29% have a recent history of opioid misuse.

Aberrant opioid use, or opioid misuse, includes any use that is contrary to what is recommended, such as taking a medication more often than prescribed, taking by routes other than recommended (i.e. crushing pills to take them intranasally or intravenously), or the intentional use of an opioid for nonmedical purposes, for the euphoric effects or to “get high.”

Opioid addiction, also called opioid use disorder, is a primary, chronic and relapsing brain disease characterized by an individual pathologically pursuing reward and/or relief by substance use. The term addiction implies a pattern of maladaptive behavior characterized by ongoing use despite harm or potential for harm, and this is present in about 10% of chronic opioid users, though in some studies as high as 1/3 of chronic opioid users met criteria for opioid use disorder. 

Physical dependence upon an opioid is a physiological consequence of chronic use and is not necessarily indicative of behavioral patterns of misuse or substance use disorder.

The DSM-5 uses terminology focused upon “substance use disorders”, rather than addiction, and divides these into categories based upon severity: mild, moderate, and severe. Terms like abuse have fallen out of favor due to conveying a greater degree of volition than recent neuroscience suggests patients with addiction are able to exert.  Along similar lines, terms like “addict” or “substance abuser” are considered overly stigmatizing and person-centered language (“patient with an opioid use disorder) is preferred.

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