Understanding and Preventing Opioid Misuse and Abuse (DRAFT)

This chapter describes the dynamics of opioid misuse and abuse, and of opioid use disorder, as a basis for choosing risk mitigation strategies. Its opening words capture the dichotomy confronting the physician, describing opioids’ virtues and simultaneous risks. Factors contributing to the misuse and compulsive use of opioids preface a review of the best practices in prevention: prescription drug monitoring programs (PDMPs), consultation and collateral source interrogation, lost prescription replacement policies, and development of and mutual adherence to formal monitoring plans. The chapter is directed to all physicians in clinical practice. Included is a table describing appropriate and inappropriate opioid use, with clinical examples. A second table distinguishes medical from nonmedical uses of opioids according to intent, effect, pattern, control, and legality. A final table distinguishes between the physician’s and the patient’s responsibilities.