Pathway

Addressing Pain Management & Opioid Use/Abuse

Building a Business Case: Pathway to Addiction

Pathway to addiction

Opioids are prescribed therapeutically to relieve pain. Prolonged use of opioids leads to changes in the brain’s opioid receptors causing them to gradually release less of the chemicals that relieve pain. This process can result in:

  1. Dependence – The need to take the drug to prevent withdrawal symptoms
  2. Addiction – Compulsive use despite harm or negative consequences

Many factors, including genetics and physical and psychosocial stressors, can impact how quickly a person moves from dependence to addiction.7

Repeated exposure to increasing doses of an opioid changes the brains structure so that it functions relatively normally when the drugs are present and abnormally when they are absent. In some cases, opioid tolerance may prevent a person from experiencing pleasure from everyday activities such as eating.

The CDC gathered data from a large commercial claims database to evaluate the probability of long term opioid use after patients were prescribed initial opioid therapy for acute non-cancer pain. Close to 3% of the approximately 1.3 million people in the database receiving an initial opioid prescription continued to use opioids at one year. The majority (70%) received an initial prescription for ≤ 7 days.

The results demonstrated an increased rate of long term use as the number of days a patient consumed opioids increased (see table below). Other factors associated with increased length of utilization included increased age, female gender, diagnosis of a painful condition, starting on higher doses or long acting opioids and being insured through a public option (e.g. Medicare or state Medicaid).8

Length of opioid prescription for acute pain in days Percent of patients using opioids one year following treatment for acute pain
1 6%
≥8 13.5%
≥31 29.9%

Because people receiving opioids are at risk for misusing or abusing the medication, guidelines for the use of chronic opioids in non-cancer pain recommend that prescribers evaluate patients on long term opioid therapy for signs of abuse or misuse.

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