Is there evidence that the lower the daily dose (total daily amount) of opioids for i.e., non-cancer pain there is a lower risk of addiction?
I have not found a paper suggesting this relationship but perhaps you know of one or a nonpublished study.
Thank you, Lou
In the majority of situations, a physician does not initiate opioid therapy with the intention of continuing it for months or years, but many patients will continue to seek opioids for relief of pain which becomes chronic. Cancer pain treatment became successful with aggressive opioid prescribing. The success of aggressive opioid therapy for cancer pain treatment led to a spillover into chronic non-cancer pain treatment, spurred on by industry-supported continuing medical education programs. As high-dose opioids became more available in the community, it was accompanied by a pattern of escalating drug diversion, opioid misuse, accidental opioid overdose, and deaths that continued to climb through the past decade.
www.rimed.org/rimedicaljournal/2014/10/2014-10-25-dadt-burgess.pdf
There is continuing reluctance to prescribe strong opioids for the management of chronic non-cancer pain due to concerns about side-effects, physical tolerance, withdrawal and addiction. Randomized controlled trials have now provided evidence for the efficacy of opioids against both nociceptive and neuropathic pain. However, there is considerable variability in response rates, possibly depending on the type of pain, the type of opioid and its route of administration, the time to follow-up, compliance and the development of tolerance.
http://onlinelibrary.wiley.com/doi/10.1053/eujp.2001.0240/abstract
Thanks for the references. More specifically I am looking for evidence that there is a correlation or even a direct relationship between the total daily input by any route (oral, im, iv, patch) of an opioid for any animal although human is the preferred subject AND the outcome of physiological dependence or addiction. Thanks.
Hi, Louis, I attach a related article by Wasan AJ et al for this nice topic.
Craving of Prescription Opioids in Patients with Chronic Pain: A Longitudinal Outcomes Trial.
Thanks Victor. Very relevant. Do you think that I can interpret this study to suggest that it is possible that adherence to the lowest effective dose can reduce craving. Or am I stretching the results?
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