The Need to Identify Predictors of Aberrant Drug-Related Behavior and Addiction in Patients Being Treated with Opioids for Pain

Friedman et al. [1] identified a crucial need for the field of pain management and the future of chronic opioid therapy in noncancer pain—the need to be able to screen for and identify patients at risk for aberrant behavior and addiction in the context of their pain therapy. While their work is suggestive, it is only a start. What is truly needed (and indeed it is glaring that such a study has not yet been carried out) are large epidemiologic surveys of risk factors evaluated prospectively as patients enter into treatment and are then followed for a meaningful time period (i.e., 1-year minimum, if not longer). The conclusions from such studies would be extremely valuable to practicing clinicians in that they could be employed not to justify excluding patients from treatment with opioids in the face of severe pain, but to plan for and put in place safeguards and structures in the treatment approach that would potentially enable such patients to enjoy good outcomes.