[Show abstract][Hide abstract] ABSTRACT: The use of opioids for chronic noncancer pain has increased dramatically over the past 25 years in North America and has been accompanied by a major increase in opioid addiction and overdose deaths. The increase in opioid prescribing is multifactorial and partly reflects concerns about the effectiveness and safety of alternative medications, particularly the nonsteroidal anti-inflammatory drugs. However, much of the rise in opioid prescribing reflects the assertion, widely communicated to physicians in the 1990s, that the risks of dependence and addiction during chronic opioid therapy were low, predictable, and could be minimized by the use of controlled-release opioid formulations. In this narrative review, we offer a critical appraisal of the publications most frequently cited as evidence that the risk of addiction during chronic opioid therapy is low. We conclude that very few well-designed studies support the notion that opioid addiction is rare during chronic opioid therapy and that none can be readily generalized to present-day practice. Despite serious methodological limitations, these studies have been repeatedly mischaracterized as showing that the risk of addiction during chronic opioid therapy is rare. These studies are countered by a larger, more rigorous and contemporary body of evidence demonstrating that dependence and addiction are relatively common consequences of chronic opioid therapy, occurring in up to one-third of patients in some series.
Journal of medical toxicology: official journal of the American College of Medical Toxicology 10/2012; 8(4). DOI:10.1007/s13181-012-0269-4
[Show abstract][Hide abstract] ABSTRACT: The current epidemic of prescription opioid abuse can be traced to systematic reviews of the prevalence of iatrogenic addiction indicating that the rate was very low. This article critiques one such review and others like it. The analysis reveals that existing evidence is inadequate to answer the question.
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