Clinical Guidance: Detection and Treatment of Prescription Opioid Abuse
The epidemic of prescription opioid abuse requires early recognition and engagement of patients through motivational interviewing. Family reports or clinical suspicion based on a vague history or lack of rapport, accompanied by signs of acute opioid intoxication (constricted pupils, slurred speech, itching, euphoria or agitation, dry mouth, drowsiness, and impaired judgment) or withdrawal (dysphoric mood, nausea or vomiting, muscle aches, runny nose, watery eyes, dilated pupils, goosebumps, sweating, diarrhea, yawning, fever, and insomnia) should prompt urine toxicology. Many abused prescription opioids also contain acetaminophen, whose toxicity can be detected as elevated liver transaminase levels. Dodrill et al. (CME, p. 466) recommend buprenorphine treatment to address both the addiction and chronic pain. Methadone may be required for severe dependence. Maintenance of clinical gains requires pain management and behavioral counseling in addition to medication.