Addiction is the result of a complex web of genetic, psychological and environmental factors. Patients with a history of psychological disorders (e.g., psychosis, anxiety, personality disorders) or prior substance abuse are at greater risk for addiction when using certain prescription medications.

For this reason, physicians must exercise special care when using medications to manage acute or chronic pain in people with a history of substance abuse. It is recommended that, before starting any opioid medication, patients discuss with their physician in detail if they have had addiction to any drug or alcohol in the past.

When possible, physicians are likely to look for alternative approaches to treating pain that do not involve the use of potentially addicting medications such as opioids. For example, treatments such as exercise therapy, physical therapy or thermotherapy may ease conditions such as herniated discs or whiplash. Also, other medications such as ibuprofen or acetaminophen are tried before prescribing opioids.

However, in some situations, opioids are the best treatment option available and are prescribed to patients even if they have a history of substance abuse. In such situations, physicians may work with psychiatrists or experts in addiction medicine to reduce the risk of addiction. Physicians may also prescribe different medications and rotate them in a patient’s treatment regimen to help lower the risk of addiction to any one substance. Also, methadone clinics are available, where patients can be switched and maintained on methadone to deal with addiction.

The U.S. National Institute on Drug Abuse is launching the first large-scale national study to evaluate treatment of addiction to prescription painkillers. The 11-site Prescription Opiate Addiction Treatment Study will examine the effectiveness of buprenorphine/naloxone tablets (Suboxone), along with different kinds of drug counseling, in patients addicted to prescription opioids.