Opioid consumers: from the Pain Clinic to the

Opioid consumers: from the Pain Clinic to the Addictive
Behaviours Unit
Mansilla Sánchez S1, López Lazcano A1, Faulí Prats A1, Lligoña Garreta A1
1.Hospital Clínic Provincial de Barcelona; Barcelona, Spain
I. PURPOSE OF THE STUDY
The OMS scale for pain treatment includes opioids as an
option, and so these drugs are frequently used. In the last
years an increase in opioid prescription in western countries
has been registered. Data from the US reflect a four-fold
increase in the prescription of drugs such as oxycodone,
morphine or methadone [2]. A similar situation has been
observed in our country with morphine or fentanyl (figure 1).
Figure 1
Transdermal fentanyl
patch
Transdermal buprenorphine patch
Oral oxicodone
Product boxes
Chronic pain is a prevalent condition worldwide. Suffering it,
especially neuropathic pain, has a major impact on all aspects
of general health and early identification and management are
essential in order to minimise long term suffering and
disability [1].
Oral morphine
Ultrarapid fentanyl
Oxidone + Naloxone
Hydromorphone
Tapentadol
Oral buprenorphine
General practitioners opioid prescription in Barcelona (Institut Català de la
Salut)
Figure 2
Alarmingly, as opioid prescription rises, cases of opioid
iatrogenic dependence and its complications do so (figure 2)
Moreover, when analysing opioid consumers, co-occurring
psychiatric disorders have demonstrated to be both among its
predisposing factors and its complications [3], what calls for a
proactive role of psychiatrists in the evaluation and treatment
of these patients.
II. METHODS
We analysed data from a group of patients assisted in the Pain Clinic of a general academic hospital. Opioid use disorders had
been identified in these patients and they were therefore referred to psychiatric assessment in the Addictive Behaviours Unit.
We assessed for the next variables: age, sex, type and dose of opioid consumed and type and dose of other medications
consumed, presence of previous or current psychiatric diagnoses and type of psychiatric comorbidities.
III. RESULTS
In our sample, 95% of patients were female, with a mean age of 52.15 ± 9.9 years. The type of opioid most frequently consumed
was transmucous fentanyl (figure 3), with an average daily dose around 3400 mg, followed by transdermal fentanyl and tramadol.
A 30% of patients were being treated with more than one opioid drug. All patients but one were under benzodiazepine
treatment, being diazepam the subtype of these drugs used the most (40%); other frequently found were alprazolam and
clonazepam. Up to 80% of patients were receiving antidepressant treatment, mainly with dual drugs (25% with duloxetine, 15%
with venlafaxine) followed by far by tricyclic antidepressants and SSRI.
Figure 3
Phentanyl transmuc
Methadone
Oxycodone
Phentanyl transderm
Buprenorphine sc
Tramadol
Other
More than 60% of the sample referred previous psychiatric comorbidities. Prevalence of major depression disorder was the
highest both when analising previous and current psychiatric comorbidities (figures 4-6).
Figure 5
Figure 4
Figure 6
Previous psychiatric comorbidities
Previous or current PC
No previous or
current PC
Current psychiatric comorbidities
Anxiety disorder
Major depression
Adjustment
disorder
Suicide attempt
PTSD
Anxiety disorder
Major depression
Adjustment disorder
ADHD
IV. CONCLUSION
Given the increase in the opioid prescription registered in the last years in western countries, it is necessary to know the implications
of the use of these drugs. Considering a global view of the patient that includes comorbid psychiatric conditions is of major
importance, as it may have implications when predicting the likelihood of responding to treatment and/or the risk of developing an
addiction. Concomitant psychopharmacological treatment of opioid dependence or other drugs abuse/dependence and psychiatric
comorbidities improves outcomes (e.g. better pain tolerability/control). Factors predicting low probability of response to opioid
treatment and high risk of abuse, such as concomitant benzodiazepine use, have shown to be prevalent in our population and call
for an intensive intervention in these patients.
References:
[1]Blair H Smith and Nicola Torrance. Epidemiology of Chronic Pain. Systematic Reviews in Pain Research. Ed IASP PRESS 2008, pp 247-273.
[2] Manchikanti L, Singh A. Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician.
2008 Mar;11(2 Suppl):S63-88.
[3]Wilsey BL, Fishman SM, Tsodikov A et al.. Psychological comorbidities predicting prescription opioid abuse among patients in chronic pain presenting to the emergency department.
Pain Med. 2008 Nov; 9 (8): 1107-17.
P.6.d.015
Opioid consumers: from the pain clinic to the addictive behaviours unit
S. Mansilla Sánchez 1, A. López Lazcano 2, A. Faulí Prats 3, A. Lligoña Garreta 1
1Hospital Clínic Universitari Barcelonaa Psychiatrya Barcelonaa Spain
2Hospital Clínic Universitari Barcelonaa Psychologya Barcelonaa Spain
3Hospital Clínic Universitari Barcelonaa Anaesthesiologya Barcelonaa Spain
Purpose of the study: Chronic pain is a prevalent condition worldwide. Suffering it, especially neuropathic pain,
has a major impact on all aspects of general health and early identification and management are essential in
order to minimise long term suffering and disability [1]. The OMS scale for pain treatment includes opioids as an
option, and so these drugs are frequently used. In the last years an increase in opioid prescription in western
countries has been registered. Data from the US reflect a four-fold increase in the prescription of drugs such as
oxycodone, morphine or methadone [2]. A similar situation has been observed in our country with morphine or
fentanyl. Alarmingly, as opioid prescription rises, cases of opioid iatrogenic dependence do so. Moreover, when
analysing opioid consumers, co-occurring psychiatric disorders have demonstrated to be both among its
predisposing factors and its complications [3], what calls for a proactive role of psychiatrists in the evaluation and
treatment of these patients.
Methods: We analysed data from a group of patients assisted in the Pain Clinic of a general academic hospital.
Opioid use disorders had been identified in these patients and they were therefore referred to psychiatric
assessment in the Addictive Behaviours Unit. We assessed for the next variables: age, sex, type and dose of
opioid consumed and type and dose of other medications consumed, presence of previous or current psychiatric
diagnoses and type of psychiatric comorbidities.
Results: In our sample, 95a of patients were female, with a mean age of 52.15±9.9 years. The type of opioid
most frequently consumed was transmucous fentanyl, with an average daily dose around 3400mg, followed by
transdermal fentanyl and tramadol. A 30a of patients were being treated with more than one opioid drug. All
patients but one were under benzodiazepine treatment, being diazepam the subtype of these drugs used the
most (40a); other frequently found were alprazolam and clonazepam. Up to 80a of patients were receiving
antidepressant treatment, mainly with dual drugs (25a with duloxetine, 15a with venlafaxine) followed by far by
tricyclic antidepressants and SSRI. More than 60a of the sample referred previous psychiatric comorbidities.
Prevalence of major depression disorder was the highest both when analising previous and current psychiatric
comorbidities.
Conclusions: Given the increase in the opioid prescription registered in the last years in western countries, it
necessary to know the implications of the use of these drugs. Considering a global view of the patient that
includes comorbid psychiatric conditions is of major importance, as it may have implications when predicting
likelihood of responding to treatment and/or the risk of developing an addiction. Concomitant
psychopharmacological treatment of opioid dependence or other drugs abuse/dependence and psychiatric
comorbidities may improve outcomes (e.g. better pain tolerability/control). Factors predicting low probability
response to opioid treatment and high risk of abuse, such as concomitant benzodiazepine use, have shown
be prevalent in our population and call for an intensive intervention in these patients.
is
the
of
to
1. Blair H Smith and Nicola Torrance. Epidemiology of Chronic Pain. Systematic Reviews in Pain Research. Ed IASP
PRESS 2008, pp 247–273.
2. Manchikanti L, Singh A. Therapeutic opioids: a ten-year perspective on the complexities and complications of
the escalating use, abuse, and nonmedical use of opioids. Pain Physician. 2008 Mar;11(2 Suppl):S63–88.
3. Wilsey BL, Fishman SM, Tsodikov A et al. Psychological comorbidities predicting prescription opioid abuse
among patients in chronic pain presenting to the emergency department. Pain Med. 2008 Nov; 9(8): 1107–17.
Citation: Eur Neuropsychopharmacol. 2014;24aSuppl 2):S694
Keywords
Opiates
Drug dependence & abuse: clinical
Dual diagnosis