Opioid treatment must be individually fashioned to minimize the likelihood
of nonadherence, including more serious abuse, addiction and diversion,
and create an appropriate level of monitoring for these potential adverse
outcomes. Proactive strategies should be adopted at the start of therapy
based on the perceived level of this risk
(Table). Some clinicians incorporate aspects of risk management, such
as the use of an “opioid contract” into every therapy. Others
reserve the flexibility to implement no specific additional elements if
the risk of abuse, addiction or diversion is perceived to be very low.
If the assessment suggests that the risk is moderate to high, however,
any of a range of strategies may be implemented.
TABLE: Proactive Strategies that May Be Used to Reduce the Likelihood
of Problematic Drug-Related Behaviors and Increase Monitoring (.pdf)
References
Portenoy RK, Payne R, Passik S: Acute and chronic pain. In Lowinson JH,
Ruiz P, Millman RB (eds): Comprehensive Textbook of Substance Abuse, Fourth
Edition. Baltimore: Williams and Wilkins, in press.
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