Am J Psychiatry. 2022 Oct;179(10):696-698. doi: 10.1176/appi.ajp.20220592. PMID: 36181333.
What is our final lesson about prescription opioid use, misuse and POUD risk? Opioid misuse and POUD risks do not only arise from patient misbehavior or improper intentions. They are intrinsic to opioids and the roles they play in the human brain. We learned this lesson about opioid overdose risk a decade ago. While initial studies of opioid overdoses in West Virginia pointed toward drug diversion and doctor shopping as the causes of opioid overdose(26), subsequent studies showed that opioid overdose risk was strongly related to the prescribed dose of opioids.(27) This showed that overdose was an inherent risk of opioids and not simply related to patient misbehavior. Now we must learn a similar lesson about opioid misuse. Endogenous opioids evolved to modulate both physical pain and social pain to promote human survival.(28) It is not possible for laws or diagnostic criteria to pull these apart into entirely separate categories of legitimate opioid use for pain relief and illegitimate opioid misuse for mood relief.