Does this opioid naïve patient really need potent opioids? Think twice

Think Twice, exercise caution and generally avoid making assumptions about patient risk of subsequent prescription opioid use disorder, write authors of a recent editorial.

A worker in his 30’s had a “fall at work three weeks ago and has presented describing excruciating persistent back pain. An MRI scan of his spine has been normal. He has tried physiotherapy and non-steroidal anti-inflammatories for pain, but he reports persistent pain particularly when trying to work.

He wants to return to work and is requesting low dose opioid medication to allow him to work without pain stating that others he works with have been able to return to work with opioid medications. He is becoming increasingly anxious with not being able to work.

In his medical chart, it states that he is known to have a history of excessive alcohol use and states he no longer drinks because of “problems in the past.” He has no other psychiatric disorders or symptoms and is on no medications.

Is there a way to predict his subsequent risk of opioid use disorder should opioids be initiated for his persistent acute back pain?”   To find out more read the full story in the September 2020 issue of BC Medical Journal here, or listen to the recent episode of the Dope Clouds podcast.


Cited studies: Klimas, J., McCracken, R., Bassett, K., Wood, E. (2020) Think Twice: Evidence-Based approaches to pain management with opioids. BC Medical Journal 62(7):234-237

Klimas, J., Maclure, M., McCracken, R. (2021) Individualized prescribing portraits to reduce inappropriate initiation of opioid analgesics to opioid naïve patients in primary care: Study protocol. Paper presented at the virtual BC Patient Safety Quality Council Quality Forum, February 25.

If you enjoyed this post, you might enjoy reading about the risks of unsafe initiation of opioid analgesics here

Pain Management with Opioids in 2019-2020

Can prescribers avoid contributing to opioid use disorder?

Why most opioid risk tools fail?

Diagnosing opioid addiction in people with chronic pain

The opioids and addiction mismatch