Patients with a legitimate need for pain relief often find themselves caught in the middle as physicians face increasing pressure to do more to combat opioid abuse. Risk profiling patients for susceptibility for addiction before prescribing opioid medication can help physicians make the best prescribing choices for their patients.
“We can avert preventable diseases such as addiction by understanding which patients are most likely to abuse drugs,” says Richard Jermyn, DO, the director of the Neuromusculoskeletal Institute in Stratford, New Jersey. “Risk assessment lets us partner with patients in a way that helps them understand their own vulnerability, just as you would counsel a patient with obvious risks for heart disease.”
Clinically useful guides, such as the Opioid Risk Tool, offer good predictive value for physicians. Key indicators for susceptibility to addiction include:
- Being 16-45 years old.
- A family or personal history of substance abuse, including alcohol, medication and illicit drugs.
- History of preadolescent sexual abuse.
- Personality factors, including ADD, OCD, bipolar disorder, schizophrenia and depression.
- Family dynamics.
- Social factors.
Sometimes opioids are the most effective pain treatment available for patients, regardless of their risk profile, Dr. Jermyn notes. In those cases, he recommends starting patients on the lowest effective dose, followed by a monitoring system that includes regular drug testing and documentation.
“We don’t want to demonize this drug class, but we do need to increase checks and balances to protect the patient,” Dr. Jermyn says. “Even as I’m prescribing an opioid, I’m working toward a discontinuation plan that prevents addiction.”