Psychological Variables Potentially Implicated in Opioid-Related Mortality as Observed in Clinical Practice
Article first published online: 13 JUN 2011
Wiley Periodicals, Inc.
Special Issue: Deaths Related to Opioids Prescribed for Chronic Pain: Causes and Solutions
Volume 12, Issue Supplement s2, pages S36–S42, June 2011
How to Cite
Passik, S. D. and Lowery, A. (2011), Psychological Variables Potentially Implicated in Opioid-Related Mortality as Observed in Clinical Practice. Pain Medicine, 12: S36–S42. doi: 10.1111/j.1526-4637.2011.01130.x
- Issue published online: 13 JUN 2011
- Article first published online: 13 JUN 2011
- Aberrant Drug-Related Behavior;
- Accidental Overdose;
- Chronic Pain;
- Pain Management;
- Risk Assessment
Opioid-related deaths in the United States have become a public health problem, with accidental and unintended overdoses being especially troubling. Screening for psychological risk factors is an important first step in safeguarding against nonadherence practices and identifying patients who may be vulnerable to the risks associated with opioid therapy. Validated screening instruments can aid in this attempt as a complementary tool to clinicians' assessments. A structured screening is imperative as part of an assessment, as clinician judgment is not the most reliable method of identifying nonadherence. As a complement to formal screening, we present for discussion and possible future study certain psychological variables observed during years of clinical practice that may be linked to medication nonadherence and accidental overdose. These variables include catastrophizing, fear, impulsivity, attention deficit disorders, existential distress, and certain personality disorders. In our experience, chronic pain patients with dual diagnoses may become “chemical copers” as a way of coping with their negative emotion. For these patients, times of stress could lead to accidental overdose. Behavioral, cognitive-behavioral (acceptance and commitment, dialectical behavior), existential (meaning-centered, dignity), and psychotropic therapies have been effective in treating these high-risk comorbidities, while managing expectations of pain relief appears key to preventing accidental overdose.