Prevention of Opioid Abuse in Chronic Non-Cancer Pain: An Algorithmic, Evidence Based Approach

Background: The use of opioids for chronic non-cancer pain has grown exponentially in the last 15 years. Associated with that, dramatic increases in abuse and overdose deaths from opioid use have been noted. Objectives: Most opioid abuse stems from legitimate prescriptions, putting the onus on prescribers to use opioids responsibly for chronic pain. Very little evidence-based guidance exists for those who wish to prescribe opioids for legitimate chronic pain and at the same time prevent opioid abuse. Methods: A review of literature was performed for articles focused on guidelines for opioid use when prescribed for chronic pain, opioid abuse, and overdose, strategies to detect and prevent abuse of opioids, urine drug screens (UDS) in chronic pain settings, prescription monitoring programs (PMP), and the relationship between opioid dosing and abuse. Results: Based on the existing literature, an evidence-based algorithmic approach was developed to decrease opioid abuse in the chronic pain environment. The pillars of prevention are the screening of patients into high, medium, and low risk categories using screening tools; monitoring patients using UDS, PMP, and pill counts, and lastly, dose limitations. Conclusion: This algorithmic approach may enable physicians to prescribe opioids for patients with chronic pain and also to reduce opioid abuse.