Screening for problematic prescription opioid use

The proper medicinal use of opioids, in light of their notorious history an d current relation to social ills, continues to be debated and remains uncl ear in several areas of medicine. This article will review several areas an d points of controversy related to screening for potential problematic opio id behavior in chronic nonmalignant pain patients. Controversy over the pre scription of opioids for chronic nonmalignant pain continues, despite the g rowing acceptance of this practice. Indeed. past research supports the bene ficial use of opioids for noncancer pain. Unfortunately, traditional defini tions of abuse and dependence, with their emphasis on tolerance and withdra wal, are inappropriate for chronic pain patients prescribed opioids. The co mponent of traditional definitions of abuse and dependence that appears mos t applicable to chronic pain patients centers on the criterion that the pat ient continue to take the drug (in this case, the opioid) despite negative and harmful effects or despite any decrease in pain level. Although clinica l observations exist about risk factors for opioid misuse in chronic pain p atients, there is limited research. Further, the area of prescreening for p roblematic drug behavior is in its infancy. However, researchers have begun to delve into this challenging area and the application of rigorous empiri cal research will bring us closer to identifying those patients at risk so that their pain is managed without destructive outcomes in other areas of t heir life.