There is little information about the risk of abuse or addiction during or after the therapeutic administration of a potentially abusable drug to patients with current or remote histories of abuse or addiction. Anecdotal reports have suggested that successful long-term opioid therapy in patients with cancer pain or chronic nonmalignant pain is possible, particularly if the history of abuse or addiction is remote.[1,2] Although there is a lack of empirical information on this subject, it is generally accepted that the risk of aberrant drug-related behaviors during treatment for a medical disorder is higher among populations with current histories of substance abuse and, to a lesser extent, remote histories.

The most prudent actions cannot obviate risk, and clinicians must recognize that virtually any drug that acts on the central nervous system can be abused through any route of drug administration. Effective risk management of patients with substance abuse histories necessitates a comprehensive approach that recognizes the biologic, chemical, social, and psychiatric aspects of substance abuse and addiction, as well as a practical means to manage risk.

References

1. Gonzales GR, Coyle N: Treatment of cancer pain in a former opioid abuser: fears of the patient and staff and their influence on care. J Pain Symptom Manage 7 (4): 246-9, 1992.  [PUBMED Abstract]
   
   
2. Dunbar SA, Katz NP: Chronic opioid therapy for nonmalignant pain in patients with a history of substance abuse: report of 20 cases. J Pain Symptom Manage 11 (3): 163-71, 1996.  [PUBMED Abstract]