Repeated Infractions May Signal Addiction

Many pain patients taking opioids may engage in behaviors suggesting that they are abusing the drugs, Steven Passik, Ph.D., an associate attending psychologist at Memorial Sloan-Kettering Cancer Center, reported at a recent pain, opioid, and addiction conference (see “Search Is On to Discover 'Perfect' Pain Killer”). He came to this conclusion after he and his colleagues studied some 400 pain patients being treated with opioids and found that 45 percent repeatedly engaged in some suspicious behaviors.

But even if patients act in aberrant ways related to opioid use, it does not necessarily mean that they are actually abusing the drugs, he stressed. However, if patients repeatedly engage in a suspect behavior over a six-month period, then there is good reason to suspect that they are abusing the opioids.

And if misuse is likely occuring, it is crucial to determine why, Passik said. Is the patient depressed, anxious, stressed, or perhaps selling the medications for profit? It's very hard to detect patients with criminal intent, he admitted.

Easier than detecting abuse of opioids, of course, is preventing it in the first place, Passik noted. Thus pain patients should be screened for opioid-addiction risk before being treated with them. There are several screening instruments for such risk that can be administered quickly. including the Opioid Risk Tool and the Screener and Opioid Assessment for Pain Patients.