Opioid therapy

Opioid use disorder (OUD) is a prevalent condition associated with substantial morbidity, mortality, and healthcare utilization. Prescribers must rely on multiple tools and tactics to help reduce the risk of OUD. These include identification of risk factors for OUD and risk stratification, which must be individualized for each patient. Opioid diversion must be considered distinct from OUD and it has some unique risk factors. Aberrant drug-related behaviours may be observed in those taking opioids and may or may not suggest OUD; risk factors for OUD are dynamic. However, many aberrant drug-related behaviours may be harmless or misinterpreted. A variety of validated risk assessment tools are available to better quantify risk for OUD. An important factor in thwarting OUD remains patient and prescriber education as well as specialized resources such as patient–prescriber agreements, abuse-deterrent formulations of opioids, urine drug screens, and prescription drug monitoring programmes. There is no single, easy way to reduce OUD; instead, prescribers must be aware and make use of the many tools at their disposal to better pre-emptively identify those at elevated risk for OUD and to offer help to those who develop OUD over the course of prescribed opioid therapy.