Measuring abuse liability-is the risk worth taking?
Julkaisun nimi:
Measuring abuse liability-is the risk worth taking?
Tekijä:
Kalso, E. Simojoki, K.
Ingressi:
Early trials that supported short-term opioid treatment in the management of chronic non-cancer pain excluded patients at high risk of drug abuse, and might have overestimated the efficacy of this approach. The recent IMMPACT recommendations suggest inclusion of high-risk groups in future clinical trials of potentially addictive drugs. Is the risk worth taking?
Julkaisukieli:
Englanti
Julkaisutyyppi:
Muu julkaisu
Julkaisuvuosi:
2014
Julkaisun tiedot:
Nature reviews neurology 10 (3), 131-133.
Lyhyt kuvaus:
Early trials that supported short-term opioid treatment in the management of chronic non-cancer pain excluded patients at high risk of drug abuse, and might have overestimated the efficacy of this approach. The recent IMMPACT recommendations suggest inclusion of high-risk groups in future clinical trials of potentially addictive drugs. Is the risk worth taking?
Studies using modern criteria for trial design and outcome (at least 50% pain relief or no more than mild pain) suggest that opioids are no better than placebo for the relief of osteoarthritis or chronic lower back pain.10 This finding does not mean that opioids have no effect, but that only a few patients achieve meaningful pain relief, which necessitates careful consideration of the potential risks and benefits.
To conclude, opioids should preferably be used for a predetermined duration only, although long-term opioid therapy can be warranted in exceptional cases. Given that the expected benefit of long-term opioid treatment can be small and difficult to predict, it seems unethical to recruit patients to clinical trials who are at high risk of abuse of the drugs being investigated. The abuse liability for each drug can be tentatively assessed using animal models of drug reinforcement and dependence, and the abuse liability estimates can be confirmed in smaller-scale human experi-mental studies.
Keywords: management of pain, opioids, opioid therapy, drug abuse, clinical trial
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