Misuse Of Analgesics Research Articles

Measuring prescription opioid misuse and its consequences.

Prescription drug misuse in the USA increased during the 1990s to 2010. The epidemic stimulated the need new analytical strategies and techniques to understand the medications involved, user characteristics and other factors needed to address the epidemic. A strategy of mosaic surveillance has evolved. Using real world evidence, the goal is to paint a more complete profile of a drug's real world misuse using triangulation-integrating results from multiple sources, where each approach has unrelated sources of bias. Research findings have been remarkably consistent across multiple data sources. The most commonly misused opioid medications: hydrocodone = oxycodone > methadone = buprenorphine = tramadol = fentanyl (prescription form) > morphine > hydromorphone = oxymorphone > tapentadol. This rank order is similar to the number of prescriptions dispensed for each product in the USA. In the USA, prescription opioid misuse started to decrease about 2011. Typically, multiple drugs are misused together, particularly in lethal cases. Immediate release formulations are more commonly misused than extended release formulations. The introduction of tamper resistant formulations to resist crushing were followed by a decrease in misuse of those products. The rapid expansion of opioid prescribing was accompanied by increasing misuse and mortality. Interventions such as prescription drug monitoring programmes, increased law enforcement and abuse deterrent formulations have been followed by decreases in misuse of most opioid analgesics.

Complementary and Alternative Medicine: Managing Chronic Pain and Preventing Analgesic Misuse in the Community

Complementary and Alternative Medicine: Managing Chronic Pain and Preventing Analgesic Misuse in the Community

A randomized-controlled pilot trial of an online compassionate mind training intervention to help people with chronic pain avoid analgesic misuse.

Problematic use of prescribed and over-the-counter analgesics is widespread and increasing among people with chronic pain, but the availability of preventative and treatment services is limited. We evaluated a 21-day online intervention based on compassionate mind training in a prospective, randomized-controlled trial. The participants were 73 adults with concerns about their use of analgesics for chronic pain conditions. Participants completed measures of analgesic use, misuse and dependence, plus self-criticism and self-reassurance (self-inadequacy, self-reassurance, and self-hate), cognitive impulsivity (negative urgency, lack of perseverance, lack of premeditation, sensation-seeking, and positive urgency) and behavioral impulsivity (delay discounting) at baseline, postintervention, and 1-week postintervention follow-up. Following baseline assessment, participants were randomized to compassionate mind training (CMT; n = 38) or relaxation music (n = 35), both delivered online. No adverse events or safety issues were reported and high participant retention and exercise completion rates showed that the intervention was acceptable to participants. Repeated measures analysis of variance showed that by comparison with relaxation music, the CMT group had reduced prescription analgesic use, F = 6.123, p = .015, analgesic dependence, F = 14.322, p < .001, self-hate, F = 12.218, p < .001, negative urgency, F = 7.323, p = .006, and lack of perseverance, F = 7.453, p = .001, from baseline to postintervention, and those improvements were maintained at follow-up. The results show that exercises based on CMT principles and techniques and delivered online can reduce analgesic use, risk of analgesic dependence, and some aspects of self-criticism and impulsivity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Mindfulness predicts current risk of opioid analgesic misuse in chronic low back pain patients receiving opioid therapy

BackgroundAcceptance and mindfulness processes indicating psychological flexibility may be important mechanisms in chronic pain adaptation; however, their association with opioid analgesic misuse (OA) risk is unclear. The present study investigated the extent to which psychological flexibility is associated with OA misuse risk within a chronic low back pain population on long-term opioid therapy. MethodsParticipants were 156 patients presenting for treatment at an academic pain clinic. Aspects of psychological flexibility were assessed using the Mindfulness Attention Awareness Scale (MAAS) and the Acceptance and Action Questionnaire II (AAQ II). The Current Opioid Misuse Measure (COMM) determined heightened risk of opioid analgesic misuse. Participants were 59% female, 48.3 years old on average (SD = 9.8), and largely White, Hispanic. ResultsNested multiple linear regression indicated that the higher mindfulness levels predicted opioid misuse risk while controlling for pain severity, pain-related interference, pain anxiety, and acceptance. The full regression model predicted 54% of the variance in OA misuse risk. ConclusionResults suggest that psychological flexibility, particularly mindfulness processes, may be important in predicting and mitigating OA misuse risks among chronic pain patients. Non-pharmacological interventions are critical to addressing the current opioid misuse crisis.

Application of Hot Melt Extrusion Technology in the Development of Abuse-Deterrent Formulations: An Overview.

The misuse, abuse, and illicit use of prescription opioid analgesics is a global public health concern. However, there are many viable therapeutic options for the treatment of patients with chronic pain. Both intact and manipulated opioid drug products are abused by various routes such as oral, nasal, and injection, which may lead to overdose, drug addiction, and even death. To combat the abuse of these medications, regulatory agencies and pharmaceutical companies are switching their interest towards developing Abuse Deterrent Formulations (ADFs), with the intent to deter the abuse of opioid products to a maximum extent. There are several manufacturing strategies implemented in an attempt to develop ADFs. An example includes matrix tablets of high molecular weight polymers such as polyethylene oxide. The scalable and continuous manufacturing techniques, such as Hot-Melt Extrusion (HME), is increasingly accepted by pharmaceutical companies to advance the development and manufacturing of ADFs. The application of the HME technique in the development of ADFs may overcome the challenges of opioid analgesic formulation development and provide improved protection against misuse and abuse, while also ensuring access to safe and effective use in patients with chronic pain. This review deals with a brief overview of strategies, with emphasis on HME to deter opioid abuse, in vitro characterization methods, commonly used excipients in the development of ADFs, and regulatory standards to meet the requirements of ADFs.

National estimates of substance use, substance use disorders, and treatment among adolescent and young adult cancer survivors.

7042 Background: Adolescent and young adult (AYA) survivors of cancer are at an elevated risk of early-life morbidity and mortality due to the disease trajectory and treatment. Engagement in risk behaviors, including substance use, can exacerbate survivors’ vulnerabilities and place them at further risk for adverse health outcomes. This study provides national estimates of the prevalence of substance use and misuse, substance abuse or dependence (i.e., substance use disorders [SUD]), and receipt of treatment for SUD among AYA cancer survivors. Methods: We used 2015-2018 National Survey of Drug Use and Health data to identify a nationally-representative AYA sample (aged 12-34 years). Outcomes included past-year alcohol use, marijuana use, other illicit drug use, misuse of any prescription psychotherapeutic drugs (including opioid analgesics, stimulants, sedatives, or tranquilizers), and misuse of prescription opioid analgesics. Outcomes also assessed past-year SUD in aforementioned drug classes. Among those with SUD, we evaluated past-year receipt of SUD treatment. Multiple logistic regressions were estimated to compare outcomes between 846 AYAs who reported a cancer history and 142,870 AYAs who did not, adjusting for sociodemographic and need-related characteristics. Results: In bivariate analyses, AYAs with a cancer history were more likely than noncancer peers to use alcohol (78.6% vs. 63.4%; p&lt; 0.001) and illicit drugs other than marijuana (11.2% vs. 7.8%; p= 0.02), misuse any prescription psychotherapeutic drugs (16.9% vs. 10.6%; p&lt; 0.001) and prescription opioid analgesics (12.0% vs. 5.9%; p&lt; 0.001), and have an illicit drug (other than marijuana) SUD (3.7% vs. 1.3%; p&lt; 0.01) in the past year. In regression analyses, differences in past-year misuse of any prescription psychotherapeutic drug and prescription opioid analgesics persisted ( p= 0.02, p&lt; 0.01, respectively). Among AYAs with SUD, those with a cancer history were more likely than noncancer peers to receive SUD treatment (21.0% vs. 8.1%; p= 0.01) in the past year; this difference persisted in regression analyses ( p= 0.03). Conclusions: AYAs with a cancer history had an elevated risk for misusing prescription psychotherapeutic medications, which was driven by misuse of prescription opioids; yet, only one in five AYAs with a cancer history and SUD received treatment. Our findings underscore the need for future interventions designed to reduce substance use and misuse and improve access to SUD treatment in AYA cancer survivors.

Public Attitude and Perception about Analgesic and their Side Effects

Introduction: Analgesics are substances which work in various ways to relieve different types of pain experienced in the body. Non-prescription over-the-counter (OTC) drugs are widely used by patients to control pain and fever.&#x0D; Study Objective: To evaluate of knowledge, attitudes and practices about analgesic and their side effects.&#x0D; Methods: A cross-sectional study conducted during a period of three months from September to December 2017 in Rafha and Riyadh - Saudi Arabia on a random sample of 237 Saudi people, the data was collected by using a self-administered questionnaire in the Arabic language. Statistical analysis was done by using MS EXCEL using descriptive statistics and chi-square test.&#x0D; Results: A total of 237 participants out of 260 consented to be interviewed and completed the questionnaire with a response rate (91%). Their ages ranged between 18 years and 54 years with a mean (28) and standard deviation (7.9). Majority of participants were females (92%) and about two thirds (66%) were highly educated. A quarter of study participants (25%) do not read leaflet of analgesic before use. About one-fifth of respondents (20%) reported that they cannot stop taking analgesic even if the pain is mild. 12% and 36% of respondents always and sometimes, respectively, use more than one type of analgesic for pain relief. 10% of respondents reported the occurrence of side effects from analgesic. The respondents use analgesic mainly for headache (43%) and toothache (25%). The chronic disease for which participants take analgesic were mainly arthritis (39%) and migraine (30%).&#x0D; About three-quarters of respondents (74%) were aware that the use of analgesic is accompanied by side effects. The respondents believed that the reasons for analgesic misuse are that analgesic easily obtained without a medical prescription (40%) and there is no educational or awareness program regarding analgesic use (33%). Majority of participants believed that there is no sufficient awareness about analgesic. The source of information about analgesic for participants is physician (24%). Panadol analgesic is the most commonly used analgesic (48%) reported by participants.&#x0D; Results showed that there is a significant statistical difference between male and female regard analgesic use (P=0.048) and between different level of educations and analgesic use (P=0.334).&#x0D; Also, there is a highly significant statistical difference between male and female regard reading the leaflet before taking analgesic (P=0.0001) and between the educational level of participants regarding reading the leaflet before analgesic use (P=0.0008).&#x0D; Conclusion: The over-the-counter (OTC) analgesic drugs are commonly used and many patients are unaware of their side effects. The findings of this study showed that people's knowledge, attitudes and practices regarding analgesic use is poor. Also, it is important to improve people's knowledge, attitudes and practices regarding analgesic use to reduce the misconceptions and misguided expectations contributing to inappropriate analgesic use. Therefore, health professional practice should play a major role in people's awareness of the appropriate use of OTC analgesic drugs.

An Effective Intervention: Limiting Opioid Prescribing as a Means of Reducing Opioid Analgesic Misuse, and Overdose Deaths.

Overdose deaths involving prescription opioids killed more than 17,000 Americans in 2017, marking a five-fold increase since 1999. High prescribing rates of opioid analgesics have been a substantial contributor to prescription opioid misuse, dependence, overdose and heroin use. There was recognition approximately ten years ago that opioid prescribing patterns were contributing to this startling increase in negative opioid-related outcomes, and federal actions, including Medicare reimbursement reform and regulatory actions, were initiated to restrict opioid prescribing. The current manuscript is a description of those actions, the effect of those actions on opioid prescribing and related patient outcomes. We also describe our proposal of methods of expanding these efforts as an important piece to further reduce opioid-related misuse, dependence, and overdose death.

Supplemental Material for A Randomized-Controlled Pilot Trial of an Online Compassionate Mind Training Intervention to Help People With Chronic Pain Avoid Analgesic Misuse

Supplemental Material for A Randomized-Controlled Pilot Trial of an Online Compassionate Mind Training Intervention to Help People With Chronic Pain Avoid Analgesic Misuse

Policies affecting the supply and access of opioid analgesics: a scoping review protocol.

This scoping review aims to describe and map the range of evaluated policies that affect the supply and access of opioids for analgesic therapy. There has been increasing concern regarding the rise in opioid analgesic misuse and related harms, including overdose deaths. In response, policies have been developed and implemented to reduce the burden of opioid-related problems, including strategies that aim to affect the supply and/or access of opioid analgesics. However, little is known about the range and nature of these policies, including whether they have been evaluated for effectiveness and how. Studies to be included must evaluate the effectiveness of policies directly designed to affect the supply and/or access of opioids for analgesic therapy, and measure clinical and health services outcomes quantitatively. Studies that assessed interventions or factors impacting the use of these policies, measured only utilization of the policy itself, and/or measured outcomes regarding attitudes and behaviors towards these policies will be excluded. Literature on policies for the treatment and management of opioid abuse, overdose, or addiction will be excluded. Multiple databases will be searched including MEDLINE, Embase, PsycINFO, Scopus, and Web of Science using keywords, indexed terms, and phrases for the following concepts: opioid, policy, evaluation, and clinical context. Each included study will be rated using a modified version of the JBI Levels of Evidence framework. Details on included policies and their assessment will be extracted, and results presented in diagrams and tables.

How Patient Education Influences Utilization of Nonpharmacological Modalities for Persistent Pain Management: An Integrative Review

ObjectivesOpioid analgesic misuse and abuse has given rise to an epidemic that has added to an increase in opioid-related overdoses and deaths. Adults with persistent noncancer pain (PNCP) are primarily treated with opioid analgesics. Many remain on these medications long term. Most of these patients are unaware of other effective measures for managing PNCP, such as nonpharmacologic modalities (NPMs). This lack of familiarity with NPMs presents a key contributor to the problem of NPM underuse among adult PNCP patients. This integrative review sought to identify key factors that contribute to NPMs underuse and the effect of education on patients’ adoption or use for PNCP management. DesignIntegrative review. Data SourcesA literature search was conducted using PubMed, CINAHL, Embase, Cochrane, and hand-searching of the literature published between 2002 and November 2017. Review/Analysis MethodsSystematic screening using the Johns Hopkins Nursing evidence appraisal tools yielded articles that were analyzed and synthesized to identify themes, and patterns. ResultsNineteen research articles were identified with these main themes: NPMs are effective in PNCP management, lack of familiarity with NPMs influences patients’ willingness to try them, and access to local NPMs must be addressed to facilitate use. ConclusionsFindings suggest that patient education about NPMs has the potential to motivate patients to try these modalities, which may increase overall use of NPMs for PCNP. Nurses could play a vital role in ensuring evidence-based NPMs are introduced to PNCP patients, which could increase patients’ use of these measures and improve outcomes.

The Effect of Self-Medication with NSAIDs on GIT in Orthopaedic Patients

Self-medication is a gradually increasing entity in a healthcare system. It leads patients towards greater independence in taking decisions about management of minor illnesses. It ensures access to medication and limits delayed diagnosis, worsening of disease evolution, the cost burden of drugs in comparison to prescribed drug. The aim of the study was to evaluate the prevalence of the use of NSAIDs as in the form of analgesics for self-medication with their associated risks especially GIT symptoms. This cross-sectional study was done at Holy Family Red Crescent Medical College Hospital, Dhaka, July 2018 to December 2018 for 6 months among the patients who registered to visit Orthopaedic OPD for their musridoskeletal problems. A pretested and validated questionnaire was used to collect data. There were 97% response rate recorded. The study included 571 randomly selected patient aged between 20 to75 years, of which 55.3% were from urban areas versus 44.7% from rural areas, females being dominant (69.32%). The drugs which was surveyed, were used by 84.8% of the study population, in most cases the administration being made without prior professional advice. Of the 331 participants prom urban areas, 89% used the self-medication, compared with 58.31% in rural areas. Paracetamol (46.34%), followed by Ketorolac (24.47%) and Diclofenac (22.7%) are among the most widely used analgesics, both in urban and rural areas. The most frequent symptoms that required self-medication were: low back pain (urban and rural are), neck pain (predominantly urban) and knee joint pain (predominantly rural areas). Misuse of analgesics and anti-inflammatory drugs, both in urban and rural areas is a burning issue. The growing economy improvised urban and rural people to avail the medications without knowing the risks. Close monitoring, a multilevel venture between all concerned -patients, physicians and pharmacists to provide the supervised education and appropriate information on safe self-medication for the accomplishment of national goals, are suggested plan of action. It will maximize the benefit and minimize the risks.

High Prevalence of Misuse of Prescribed Opioid Analgesics in Patients with Chronic Non-Cancer Pain

ABSTRACTOpioid analgesic misuse by patients with chronic non-cancer pain is increasing in Western countries. To determine the extent of opioid misuse by patients with chronic non-cancer pain followed at a French pain management clinic. A questionnaire on pain (severity, causes and management) and opioid misuse (based on the 11 DSM-V criteria for substance abuse disorders) was administered by a health professional to patients during a short hospitalization. During the study period (September 1, 2015 to March 31, 2016), 52 patients (73.1% women; median age = 50 years [IQR25-75: 43–57]) responded to the questionnaire. Chronic pain was caused by fibromyalgia in 55.6% of patients, and was mainly classified as neurogenic (32.6%), nociceptive (30.4%), and psychosomatic (15.2%). At hospitalization, the median pain visual analog scale score was 7/10 [IQR25-75: 6–8], despite the ongoing treatment. The opioid misuse evaluation suggested the presence of misuse in 76.9% of patients (≥2 DSM-V criteria) that was severe in 52% of patients (≥6 DSM-V criteria). Our data highlight the high prevalence of misuse of prescribed opioids by adults with chronic non-cancer pain. A consultation with an addiction specialist should be included in the management of such patients.

Opioid analgesic misuse and abuse: an Australian perspective

There has been a lot published recently about prescription opioids. There is certainly a problem regarding the apparent overuse of opioid analgesics and the consequent risks and harms. We have been aware of an ongoing crisis in the US, and now we are beginning to see an effect in Australia and the rest of the developed world ...

Complex regional pain syndrome - False hopes and miscommunications.

Complex regional pain syndrome (CRPS) has been considered to be an autoimmune disease and there have been clinical trials with intravenous immunoglobulin. Often the etiology of the so-called CRPS diagnosis cannot be discerned and there are no validated instruments that provide functional metrics. The term complex regional pain syndrome (CRPS), coined in 1994 to describe patients in whom the pain is out of proportion to the injury, was actually a diagnosis proposed during the American Civil War, but was originally known as causalgia. Physicians have long observed similar sensitivity and inflammatory symptoms following periods of immobilization and disuse, which generally resolve within a few months of remobilization. Following the original description, persistent disproportionate pain would come to be known under many other names until researchers theorized that it was related to dysfunction in the sympathetic nervous system, after which it acquired the moniker, Reflex Sympathetic Dystrophy ("RSD"). In the latter quarter of the twentieth century, after researchers failed to prove the connection between the pain and the sympathetic nervous system, a small cadre of physicians-without rigorous science-invented CRPS. This new descriptor, CRPS, has become not only a diagnosis without objective data but with proposed criteria involving ambiguous signs and symptoms with low specificity. It has led to patients being treated erroneously with sympatholytic drugs, with or without pharmaceutical or surgical blockade of the sympathetic nervous system, unwarranted use of ketamine infusions, inappropriate use of narcotics and nerve stimulation. Intravenous immunoglobulin infusions have not been effective in the treatment of chronic pain. The indiscriminate use of pain medications to treat subjective symptoms of unclear diagnoses can be a risk factor for opioid and analgesic misuse or abuse.

La crise des overdoses américaines : une menace pour la France ?

Since the 2000s, a concerning increase in opioid-analgesic-related overdoses and deaths has been reported in the United States. In contrast with opioid overdoses reported in the 80-90s mostly involving heroin, currently it is the misuse of opioid analgesics that is mainly responsible for opioid overdoses. This crisis is related to factors (not limited to the US) which occurred during the 90s and which have led to a broad prescription of opioids in non-cancer pain. In Europe and France, there is (but to a much lesser extent) an increase in strong opioid consumption and in opioid prescription related morbi-mortality. This situation, which can be described as “worrying” today, requires awareness among the French medical community, both upstream (rational prescription of opioids) and downstream (optimal management of opioid poisoning) from the opioid prescription.

Computer-based personalized feedback intervention for cigarette smoking and prescription analgesic misuse among persons living with HIV (PLWH)

Pain, tobacco cigarette smoking, and prescription opioid misuse are all highly prevalent among persons living with HIV (PLWH). Smoking and pain medication misuse can lead to deleterious outcomes, including more severe pain and physical impairment. However, we are not aware of any interventions that have attempted to address these issues in an integrated manner. Participants (N = 68) were recruited from an outpatient infectious disease clinic and randomized to either a computer-based personalized feedback intervention (Integrated PFI) that aimed to increase motivation, confidence, and intention to quit smoking, and decrease intentions to misuse prescription analgesic medications, or a Control PFI. Results indicated that PLWH who received the Integrated PFI (vs. Control PFI) evinced greater post-treatment knowledge of interrelations between pain and tobacco smoking. Moreover, participants who received the Integrated PFI and smoked at least 10 cigarettes per day (but not < 10 CPD) reported greater confidence and readiness/intention to quit smoking. Effects of the Integrated PFI on knowledge of pain and opioid misuse, and attitudes/intentions regarding prescription pain medication misuse were not statistically-significant. Taken together, these results indicate that this novel intervention strategy may offer promise for addressing a critical public health need in a population that is generally underrepresented in clinical research.

Chronic Pain Opioid-Maintained Patients Receive Less Analgesic Opioid Prescriptions.

Treating pain and opioid use disorder represents a clinical challenge. While most studies that have assessed opioid analgesic use in opioid substitution treatment (OST) patients primarily address opioid analgesic misuse (1, 2), only few studies focused on OST patients assessed the prescription of analgesic opioids for chronic pain. We sought to compare the prevalence of analgesic opioid prescription (AOP) in two groups of chronic non-cancer pain (CNCP) patients: OST patients vs. the general population. This was a population-based cross-sectional study based on the French national healthcare claims database SNIIRAM (Système National d'Informations Inter-Régimes de l'Assurance Maladie) covering over 66 million people (98.8% of the French population). Overall, 67,173 participants ≥15 years old undergoing continuous OST in 2015 (“OST patients” group) were included and age- and gender-matched by means of a 1:1 ratio with 67,173 patients without OST (“control” group). In each group, patients with cancer conditions were excluded and those having received opioid and non-opioid analgesics for at least 3 months were identified (CNCP patients). Compared to control patients, CNCP OST patients received less AOP (47.8 vs. 68.0%, p < 0.0001) and more often non-opioid prescription (52.2 vs. 32.0%, p < 0.0001). In multivariate analysis, CNCP OST patients were 2.7 times less likely to be prescribed analgesic opioids (adjusted odds ratio [OR] = 2.7 [2.42–3.01], p < 0.0001) than control patients. AOP correlated in CNCP OST patients with: age ≤ 40 years old, female gender, low-income status, methadone-maintained treatment, mental health disorder, hepatitis C virus (HCV) infection, and alcohol abuse disorder. Opioid analgesics were less often prescribed in CNCP OST patients. AOP prevalence was 2.7-fold lower than in the general population. Chronic pain management in OST patients needs to be reinforced through additional physician training and a multidisciplinary approach.

Trends in intentional abuse or misuse of benzodiazepines and opioid analgesics and the associated mortality reported to poison centers across the United States from 2000 to 2014

Context: Prior works demonstrates an increased risk of death when opioid analgesics and benzodiazepines are used concomitantly to gain a high. Using poison center data, we described trends in abuse or misuse of benzodiazepines and opioid analgesics. We quantified mortality risk associated with abuse or misuse of benzodiazepines, opioid analgesics and the combination of opioid analgesics and benzodiazepines.Methods: This was a retrospective chart review of data from the National Poison Data System which collects information from 55 poison centers located across the United States. We identified reported cases of “intentional abuse or misuse” of benzodiazepine and/or opioid analgesic exposures. Poisson regression was used to compare the number of cases from each year between 2001 and 2014 to the year 2000. Logistic regression was used to determine whether cases exposed to both benzodiazepines and opioids had greater odds of death relative to cases exposed to opioid analgesics alone.Results: From 2000 to 2014, there were 125,485 benzodiazepine exposures and 84,627 opioid exposures among “intentional abuse or misuse” cases. Of the benzodiazepine exposures, 17.3% (n = 21,660) also involved an opioid. In 2010, exposures involving both opioids and benzodiazepines were 4.26-fold (95% CI: 3.87–4.70; p < .001) higher than in 2000. The risk of death was 1.55 (95% CI: 1.01–2.37; p = .04) times greater among those who used both an opioid and a benzodiazepine compared to opioids alone. This association held after adjusting for gender and age.Conclusion: Intentional abuse or misuse of benzodiazepines and opioids in combination increased significantly from 2000 to 2014. Benzodiazepine abuse or misuse far exceeded cases of opioid abuse or misuse. Death was greater with co-abuse or misuse of benzodiazepines and opioids. Population-level campaigns to inform the public about the risk of death with co-abuse or misuse of benzodiazepines and opioids are urgently needed to address this overdose epidemic.

P.2.028 - Neuropharmacological effects of chronic opioid analgesic use on social cognition

Background Based on an increased public health concern regarding the misuse of opioid analgesics especially in the United States (U.S.) but also in Europe, non-medical prescription opioid use (NMPOU) has become an emerging field in addiction research [1]. Although misuse of opioid analgesics (e.g., morphine, oxycodone, fentanyl, etc.) has reached epidemic dimensions in the U.S., little is known about its neuropsychological sequelae. Social cognition such as empathy and emotion perception is an essential component for prosocial and interpersonal behaviour and is crucial for a positive therapy outcome in substance users. Studies with heroin users and opioid-substituted patients have shown deficits in emotion perception [2,3]. However, in this population, it is difficult to attribute postulated findings only to neuropharmacological effects because of confounding factors such as comorbid physical and psychiatric diseases. Aims The purpose of the present project is to investigate social cognition in relatively pure non-medical prescription opioid users to generate an improved model of chronic opioid effects on socio-cognitive functions and to perform a better calculation of opioid dose-response effects with less confounded factors mentioned before. Methods We compared 23 individuals with NMPOU with 29 matched healthy and drug-naive controls. Participants conducted the Comprehensive Affect Test System, investigating emotion perception including two channels of communication: affect recognition in faces (ARQ) and prosodic recognition (PRQ). The Multifaceted Empathy Test was used, measuring cognitive (CE) and emotional empathy (EE). Trait empathy was assessed using the German version of the interpersonal reactivity index (IRI). Additionally, screening questionnaires and interviews were conducted. Statistical analyses were performed with SPSS 23.0 using independent t-tests to determine quantitative differences between groups. The analysis of covariance (ANCOVA) was conducted to control for co-factors. Results Individuals with NMPOU showed reduced emotion perception in both channels of communication ARQ [t(50)=2.62, p=0.012] and PRQ [t(50)=3.34, p Conclusion This is the first study investigating social cognition in individuals with NMPOU. Contrary to cocaine and alcohol users displaying deficits mainly in EE, individuals with NMPOU show selective impairments in CE, indicating that the opioid system might be involved in CE processing. Similar deficits were also found in autistic patients supporting Panksepp’s neurochemical theory of autism [4]. Additionally, subjective self-ratings on cognitive and emotional trait empathy of the IRI demonstrated no differences between both groups, assuming that individuals with NMPOU are not aware of their deficits. Furthermore, the present study results indicate inferior social cognition especially in recognising and decoding emotions in faces but also in prosody. These deficits could lead to severe impairments in daily life interactions particularly in social relationships but also in physician-patient communications. Therefore, future interventions of opioid dependence should target deficits in social cognition to improve social interaction and consequently enhance therapy outcome and prevent relapse.