Pathways to prescription opioid addiction

Prescription opioid abuse is an increasing in North America. The pathways to prescription opioid addiction are likely more varied than for other substances of abuse due to the possibility of therapeutic exposure.

Objectives: The objective of this study was to determine the variety of pathways leading to addiction to pharmaceutical opioid products.

Methods: Adults with prescription opioid addiction in 3 provinces were interviewed to retrospectively determine lifetime timelines related to prescription opioid use and addiction.

Results: A total of 347 interviews were conducted. Subjects had a mean age of 38 ± 10 years (18-63 years) and 65% were male. First exposures to prescription opioids were recreational for 37% and therapeutic for 63%, with more therapeutic first exposures in those older than 35 years compared to those younger (75% vs 48%, p<0.001). The source of opioid for first recreational exposure was from friends, either for free (50%) or purchased (13%). Following first therapeutic exposure, 49% continued using prescription opioids after their supply ran out. Most (56%) had periods of regular therapeutic and/or mixed therapeutic/recreational use periods in their lifetime. For the whole group, the transition period from use to self-identified problem with prescription opioids had a mean duration of 2.7 ± 3.9 years. The mean age when participants self-identified the problem was 29 ± 9 years and the mean age when first sought treatment was 32 ± 9 years.

Conclusion: Understanding the role of therapeutic exposures in the development of prescription opioid addiction and the phenomenology of the progression from prescription opioid use to addiction, is clinically very important. This will be the premise from which prevention and treatment approaches can emanate.