RISK OF PRESCRIPTION OPIOID ABUSE IN CHRONIC PAIN TREATMENT

处方阿片类药物滥用是美国增长最快的阿片类药物/阿片类药物滥用形式。 这些药物大多来自为疼痛开出的处方。关于这一风险存在争议 使用处方阿片类药物治疗慢性非恶性疼痛时的滥用和成瘾。存在以下风险 在原发疾病患者中发展成虐待或成瘾从来没有被纵向研究过。 护理医生，他们启动了大部分阿片类药物的治疗。 一些专家建议不要在这一人群中使用阿片类镇痛剂，因为他们认为 耐受性很快就会使药物无效，成瘾的风险很高，而其他人则说 上瘾在疼痛患者中很少见，而且随着时间的推移，止痛会持续下去。两边都没有纵向 以适当的措施支持他们的论点的研究。无论如何，这些药物都是 因为疼痛是无处不在的，所以被广泛开出处方的医生 接受这种治疗的是初级保健医生。 我们建议在典型初级保健的大样本(600名患者)中研究疼痛的治疗。 不同种族的患者来确定疼痛缓解是否持续超过24个月，以及 导致滥用或上瘾的异常行为的频率。终端将基于需求侧管理 被诊断为虐待或上瘾。我们将仔细衡量被认为会增加风险的基线因素 成瘾史，如药物滥用史、家族史和精神障碍的存在，如 抑郁和焦虑。我们还将监测92名初级保健医生的处方做法 都自愿加入了这项研究。有药物滥用史的患者不会被排除在外 因为这些患者也有慢性疼痛，目前还没有基于证据的指南 这些患者造成的虐待风险增加，也不知道可以用什么方法来充分治疗他们的疼痛 没有滥用或复发的表象。 我们的最终目标是防止滥用和改善疼痛治疗。在最后一年 在这个五年计划中，我们将开始应用从纵向研究中获得的信息来制定一个 一揽子治疗指南，可在随后的随机对照试验中进行测试 照常治疗(根据我们的观察性研究的定义)。这些治疗指南是根据需要量身定做的 将在会议和期刊中传播，如我们目前所述 将药物滥用意识带入主流医学的计划。

Prescription opioid abuse is the fastest growing form of opiate/opioid abuse in the United States. Most of these medications come from prescriptions written for pain. There is controversy as to the risk of abuse and addiction when chronic non-malignant pain is treated by prescription opioids. The risk of developing abuse or addiction has never been studied in a longitudinal fashion among patients of primary care physicians who initiate most of the opioid treatment. Some experts advise against the use of opioid analgesics in this population because they believe that tolerance soon renders the medication ineffective and the risk of addiction is high while others say that addiction is rare among pain patients and that analgesia continues over time. Neither side has longitudinal studies with appropriate measures to support their arguments. In any case, the medications are being widely prescribed because pain is ubiquitous and the physicians who initiate the greatest number of patients on this treatment are primary care physicians. We propose to study the treatment of pain in a large sample (600 patients) of typical primary care patients who are ethnically diverse to determine whether pain relief continues over 24 months and what is the frequency of aberrant behaviors leading to abuse or addiction. End points will be based on the DSM diagnosis of abuse or addiction. We will carefully measure baseline factors that are thought to increase risk of addiction such as history of substance abuse, family history and presence of psychiatric disorders such as depression and anxiety. We will also monitor prescribing practices of the 92 primary care physicians who have volunteered to be included in the study. Patients with a history of substance abuse will not be excluded because these patients also have chronic pain and at present there are no evidence-based guidelines on the increased risk of abuse posed by these patients nor what methods can be used to treat their pain adequately without the appearance of abuse or relapse. Our ultimate goal is the prevention of abuse and the improvement of pain treatment. During the final year of this five year project, we will begin to apply the information learned from the longitudinal study to develop a package of treatment guidelines that can be tested in a subsequent randomized, controlled trial against treatment as usual (as defined by our observational study). These treatment guidelines, tailored to the needs of primary care physicians, will be disseminated in meetings and journals as described in our current program to bring awareness of substance abuse to mainstream medicine.