Risk of Abuse and Addiction in Populations With Drug Abuse Histories
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
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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]
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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]
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