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Diagnosing and Treating Opioid Dependence

Clinician Reviews. 2013 March;23(3):31-39
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The surge in opioid abuse highlights the importance of questioning patients about their use of prescription analgesics—and knowing when and how to intervene.

Regular monitoring, urine drug screens, and random pill counts, in which patients are typically given 24 hours to bring in their prescribed medication so it can be counted, can also help keep patients on track. Treatment for concurrent psychiatric disorders—depression, anxiety, and personality disorders are common among patients with opioid dependence—is also likely to improve treatment outcomes.

References
1. CDC. Emergency department visits involving nonmedical use of selected prescription drugs - United States, 2004-2008. MMWR Morb Mortal Wkly Rep. 2010;59:705-709.

2. Bohnert AS, Valenstein M, Bair MJ, et al. Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA. 2011;305:1315-1321.

3. Warner M, Chen LH, Makuc DM. Increase in fatal poisonings involving opioid analgesics in the United States, 1999-2006. NCHS Data Brief. 2009;22:1-8.

4. Substance Abuse and Mental Health Services Administration. Results From the 2009 National Survey on Drug Use and Health: Volume I. Summary of National Findings. Rockville, Md: SAMHSA, Office of Applied Studies; 2010. NSDUH Series H-38A, HHS publication SMA 10-4856. www.samhsa.gov/dataNSDUH/2k9NSDUH/2k9Results.htm. Accessed August 22, 2012.

5. Hser YI, Huang D, Brecht ML, et al. Contrasting trajectories of heroin, cocaine, and methamphetamine use. J Addict Dis. 2008;27:13-21.

6. Veilleux JC, Colvin PJ, Anderson J, et al. A review of opioid dependence treatment: pharmacological and psychosocial interventions to treat opioid addiction. Clin Psychol Rev. 2011;30:155-166.

7. George O, Koob GF. Individual differences in prefrontal cortex function and the transition from drug use to drug dependence. Neurosci Biobehav Rev. 2011;35:232-247.

8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed, text rev (DSM-IV-TR). Arlington, VA: American Psychiatric Association; 2000.

9. American Psychiatric Association. R 19 opioid use disorder (2012). www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=460. Accessed June 20, 2012.

10. Substance Abuse and Mental Health Services Administration. Results From the 2008 National Survey on Drug Use and Health: National Findings. Rockville, MD: SAMHSA, Office of Applied Studies; 2009. NSDUH Series H-36, HHS publication SMA 09-4434. www.samhsa.gov/data/nsduh/2k8nsduh/2k8Results.htm. Accessed August 22, 2012.

11. Brown RL, Rounds LA. Conjoint screening questionnaires for alcohol and other drug abuse: criterion validity in a primary care practice. Wis Med J. 1995;94:135-140.

12. Skinner HA. The drug abuse screening test. Addict Behav. 1982;7:363-371.

13. US Preventive Services Task Force. Screening for Illicit Drug Use: US Preventive Services Task Force Recommendation Statement. January 2008. www.uspreventiveservicestaskforce.org/uspstf08/druguse/drugrs.htm. Accessed May 7, 2012.

14. Gourlay D, Caplan Y, Heit H. Urine Drug Testing in Clinical Practice: Dispelling the Myths and Designing Strategies. San Francisco, Calif: California Academy of Family Physicians; 2006.

15. Jackman R, Purvis J, Mallett B. Chronic nonmalignant pain in primary care. Am Fam Physician. 2008;78:1155-1162.

16. McBane S, Weigle N. Is it time to drug test your chronic pain patient? J Fam Pract. 2010;59:628-633.

17. Madras BK, Compton WM, Avula D, et al. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alcohol Depend. 2009;99:280-295.

18. The InSight Project Research Group. SBIRT outcomes in Houston: final report on InSight, a hospital district-based program for patients at risk for alcohol or drug use problems. Alcohol Clin Exp Res. 2009;33:1374-1381.

19. Borges G, Walters EE, Kessler RC. Associations of substance use, abuse, and dependence with subsequent suicidal behavior. Am J Epidemiol. 2000;151:781-789.

20. Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51:390-395.

21. Smedslund G, Berg RC, Hammerstrom KT, et al. Motivational interviewing for substance abuse. Cochrane Database Syst Rev. 2011;(5):CD008063.

22. Gryczynski J, Mitchell SG, Peterson TR, et al. The relationship between services delivered and substance use outcomes in New Mexico's Screening, Brief Intervention, Referral and Treatment (SBIRT) Initiative. Drug Alcohol Depend. 2011;118:152-157.

23. Woody GE, Poole SA, Subramaniam G, et al. Extended vs short-term buprenorphine-naloxone for treatment of opioid-addicted youth: a randomized trial. JAMA. 2008;300:2003-2011.

24. Weiss RD, Potter JS, Fiellin DA, et al. Adjunctive counseling during brief and extended buprenorphine-naloxone treatment for prescription opioid dependence: a 2-phase randomized controlled trial. Arch Gen Psychiatry. 2011;68:1238-1246.

25. Johansson BA, Berglund M, Lindgren A. Efficacy of maintenance treatment with naltrexone for opioid dependence: a meta-analytical review. Addiction. 2006;101:491-503.

26. Hall AJ, Logan JE, Toblin RL, et al. Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA. 2008;300:2613-2620.

27. Zacny J, Bigelow G, Compton P, et al. College on Problems of Drug Dependence taskforce on prescription opioid non-medical use and abuse: position statement. Drug Alcohol Depend. 2003;69:215-232.

28. Kreek MJ. Rationale for maintenance pharmacotherapy of opiate dependence. Res Publ Assoc Res Nerv Ment Dis. 1992;70:205-230.

29. Mattick RP, Breen C, Kimber J, et al. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev. 2009;(3):CD002209.