Misuse and dependence on prescription opioids: Prevention, identification and treatment,Mésusage et dépendance aux opioïdes de prescription : prévention, repérage et prise en charge

B. Rolland, D. Bouhassira, N. Authier, M. Auriacombe, V. Martinez, P. Polomeni, G. Brousse, R. Schwan, P. Lack, J. Bachellier, S. Rostaing, P. Bendimerad, P. Vergne-Salle, M. Dematteis, S. Perrot
La Revue de Médecine Interne. 2017-08-01; 38(8): 539-546
DOI: 10.1016/j.revmed.2016.12.024

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Rolland B(1), Bouhassira D(2), Authier N(3), Auriacombe M(4), Martinez V(5),
Polomeni P(6), Brousse G(7), Schwan R(8), Lack P(9), Bachellier J(10), Rostaing
S(11), Bendimerad P(12), Vergne-Salle P(13), Dematteis M(14), Perrot S(15).

Author information:
(1)Service d’addictologie, hôpital Fontan 2, CHRU de Lille, CS 70001, 59037 Lille cedex, France. Electronic address:.
(2)Inserm U-987, centre d’évaluation et de traitement de la douleur, hôpital Ambroise-Paré, 92100 Boulogne-Billancourt, France.
(3)UMR Inserm 1107, faculté de médecine, pharmacologie médicale, CRPV/CEIP/CETD,
centre d’évaluation et de traitement de la douleur/institut Analgesia, CHU de
Clermont-Ferrand, F-63000 Clermont-Ferrand, France.
(4)Université de Bordeaux et CNRS USR 3413 (sanpsy), pôle addictologie, CH Ch.
Perrens et CHU de Bordeaux, 33076 Bordeaux, France.
(5)Service d’anesthésie, hôpital Raymond-Poincaré, 92380 Garches, France.
(6)Service d’addictologie, hôpital René-Muret, hôpitaux universitaires Paris
Seine-Saint-Denis, 93270 Sevran, France.
(7)Service de psychiatrie B, CHU, hôpital Gabriel-Montpied, F-63003
Clermont-Ferrand, France.
(8)Pôle hospitalo-universitaire de psychiatrie d’adultes du Nancy, centre
psychothérapique de Nancy, 54520 Laxou, France.
(9)CSAPA, hôpital de la Croix-Rousse, hospices civils de Lyon, 69004 Lyon,
(10)CSAPA centre Port-Bretagne, CHU de Tours, 37000 Tours, France.
(11)Hôpital Saint-Antoine, centre d’évaluation et de traitement de la douleur,
75012 Paris, France.
(12)Service de psychiatrie, secteur 2, CH de La Rochelle, 17019 La Rochelle,
(13)Service de rhumatologie et centre de la douleur, CHU de Limoges, 87042
Limoges, France.
(14)Service d’addictologie, CHU de Grenoble-Alpes, université Grenoble-Alpes,
38700 La Tronche, France.
(15)Inserm U-987, centre de la douleur, hôpital Hôtel-Dieu, université
Paris-Descartes, 75014 Paris, France.

Comment in
Rev Med Interne. 2018 Jun;39(6):445-446.

Since the 1990s, the use of prescription opioids has largely spread, which has
brought a real progress in the treatment of pain. The long-term use of
prescription opioid is sometimes required, and may lead to pharmacological
tolerance and withdrawal symptoms, i.e. pharmacological dependence on
prescription opioids. Occasionally, this may also lead to misuse of prescription
opioids (MPO). MPO preferentially occurs in vulnerable individuals, i.e., those
with a young age, history of other addictive or psychiatric disorders, especially
anxious and depressive disorders. MPO is associated with numerous complications,
including an increased risk of fatal overdose. Prevention of MPO begins before
the opioid prescription, with the identification of potential vulnerability
factors. A planned and personalized monitoring should be systematically
implemented. In vulnerable patients, contractualizing the prescription is
warranted. During follow-up, the relevance of the prescription should be
regularly reconsidered, according to the benefit observed on pain and the
potential underlying signs of MPO. Patients with suspected MPO should be referred
early to pain or addiction centers. The treatment of MPO should be based on
multidisciplinary strategies, involving both the addiction and pain aspects:
progressive opioid withdrawal, non-pharmacological measures against pain, or
switching to medication-assisted treatment of addiction (i.e., buprenorphine or

Copyright © 2017 Société Nationale Française de Médecine Interne (SNFMI).
Published by Elsevier SAS. All rights reserved.

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