Opioid Utilization and Misuse

Prescription opioids can and are used to treat acute and chronic pain and are often prescribed following surgery or injury and for a subset of patients with chronic pain from medical conditions such as cancer and inflammatory, neurological, and musculoskeletal conditions.

More than 11.5 million Americans, aged 12 or older, reported misusing prescription opioids in 2016. An estimated 11% of adults experience daily pain and millions of Americans are treated with prescription opioids for chronic pain. Primary care providers are concerned about patient addiction and report insufficient training in prescribing opioids.

Significant public awareness through education and guidelines from regulatory and government agencies and other stakeholders to address the opioid crisis have in part resulted in reduced opioid prescriptions. Improving education about pain conditions and their treatment for patients, families, caregivers, clinicians, and policymakers is vital to enhancing pain care.

Goals:

Decrease opioid overdoses, deaths and related adverse drug events.

Decrease opioid prescribing by utilizing a patient centered approach and increase the use of pain management and opioid best practices.

For questions or to request technical assistance contact Tanya Vadala at tvadala@ipro.org

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According to the DSM-5 Opioid Use Disorder will be diagnosed if two or more of the following symptoms are present and recurring over a 12 month period.

• Opioids are often taken in higher quantities than intended.
• Unable to stop or reduce opioid use.
• Significant time is spent in obtaining, using or recovering from the effects of opioids
• An intense craving and desire for opioids.
• Recurrent opioid use resulting in failure to fulfill major role obligations at work, school or home.
• Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
• Important social, occupational or recreational activities are given up or reduced because of opioid use.
• Recurrent opioid use in situations in which it is physically hazardous.
• Continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by opioids.
• Tolerance, as defined by either of the following:
  • Need for markedly increased amounts of opioids to achieve intoxication or desired effect
  • Markedly diminished effect with continued use of the same amount of an opioid
• Withdrawal, as manifested by either of the following:
  • The characteristic opioid withdrawal syndrome
  • The same (or a closely related) substance are taken to relieve or avoid withdrawal symptoms

Opioid Use Disorder is not diagnosed when an individual is under medical care and opioids are prescribed (unless the prescription is being abused as described above). The DSM-5 also explains that proper diagnosis depends on the stage at which the individual is in along the continuum of withdrawal – early remission, sustained remission, or maintenance therapy – and if the individual is in an environment where access to opioids is restricted. As well, the diagnosis is mild if there are two or three symptoms, moderate with four or five symptoms and severe with six or more symptoms.

2022 Clinical Practice Guidelines – 2022 CDC Clinical Practice Guideline at a Glance | Overdose Prevention | CDC

The HHS Overdose Prevention Strategy’s four main topics of focus include:

Primary Prevention

• Expanded research of new and improved prevention efforts
• Investing in community resources to help prevent harms related to substance use
• Increasing access to high-quality pain management to reduce preventable suffering
• Promoting responsible prescription of medications to protect patient safety

Harm reduction

• Increasing the availability and access to high-quality harm reduction services
• Decreasing negative effects of substance use
• Reducing stigma related to substance use and overdose

Evidence-Based Treatment

• Reducing barriers to accessing the most effective treatments
• Using motivational and cultural enhancements to encourage those who might be reluctant
• Advancing strategies to improve engagement and retention
• Continuing to develop new therapeutic approaches

Recovery Support

• Improve recovery support by developing different types of support throughout the lifespan
• Increasing the quality of services
• Supporting the recovery workforce
• Expanding access to ongoing, affordable, and effective recovery support services

Learn more at: Overdose Prevention Strategy (hhs.gov)