The cycle of addiction: What doctors must know to address opioid abuse

A key element in combating the deadly epidemic of prescription opioid abuse is learning how addictions begin, and new research from the Mayo Clinic provides physicians with important insights into the cycle, according to an article from the Huffington Post.

For the study, researchers analyzed the medical records of 293 patients given a short-term prescription for opiates, typically for acute pain, for the first time in 2009. The doctors did not expect patients in these cases, given the temporary nature of their sprained ankles and surgical recoveries, to become long-term users of the drugs. Nonetheless, one-quarter of the patients went on to use opioid painkillers for longer than 90 days, researchers found. Within this subset, 25 percent received at least 120 days' worth of pills or more than 10 separate prescriptions. 

Although it is unknown how many long-term users of the medications became addicted, experts believe extended use to be a strong predictor of dependence, according to the article.

Opioid addiction may also be foreshadowed in patients with histories of other addictions, the team found. For example, about 37 percent of smokers in the study used painkillers for at least 90 days, compared to 20 percent of non-smokers. More than half (51 percent) of patients with a history of substance abuse exceeded the 90-day mark as well, compared to 24 percent of those with no history. 

Identifying these risk factors--and determining how to proceed--has become a nonstop challenge for physicians, as Kurt Bravata, M.D., a primary care physician in rural Missouri, explained in a recent post for the American Academy of Family Physicians (AAFP).

"On a daily basis, I must decipher the complex motives of each patient who comes into my office seeking controlled substances to treat complaints of pain, anxiety and attention-deficit disorder," he wrote. "I also try to determine what illegal substances they may be using."

Bravata's strategy has been to not just identify addictions, but also to treat them right in his clinic using medication-assisted therapy and counseling. Getting patients to accept and follow through with treatment has been a challenge, Bravata admitted, adding that he has used motivational interviewing and family involvement to get patients through the program.

To learn more:
- read the article from the Huffington Post
- see the post from the AAFP