J Korean Med Assoc.  2022 Jan;65(1):57-65. 10.5124/jkma.2022.65.1.57.

Safe use of opioids

• Go SI
• Won YW
• Kang JH

• KMID: 2525109
• DOI: http://doi.org/10.5124/jkma.2022.65.1.57

Abstract

Background
Opioids are effective analgesics for cancer pain and refractory non-cancer pain. Although they are essential medication, problematic issues on aberrant behavior and adverse events have rapidly emerged as social problems in Korea. This study aimed to describe the mechanisms, efficacy, and adverse events, especially how to deal with opioid dependency.
Current Concepts
Opioid-induced aberrant behavior includes physical and psychological dependences (addiction), abuse, and diversion (giving prescribed opioids to another person). Most physicians are unfamiliar with how to handle patients presenting these problematic issues. Physical and psychological dependences develop through different pathophysiologic mechanisms, i.e., noradrenergic and dopaminergic pathways, respectively. Motivational enhancement therapy, psychosocial support, substitution therapy with buprenorphine, and adjunctive medications, including alpha-2 adrenergic agonist, antidepressants, and non-steroidal antiinflammatory drugs, are the mainstay of treatment for opioid dependency. Constipation, nausea/vomiting, drowsiness/sedation, delirium, itching sensation, voiding difficulty, dry mouth, opioid-induced hyperalgesia, and respiratory depression are well-known physical side effects of opioid consumption.
Discussion and Conclusion
Research on the development history, epidemiology of opioid dependency, and its treatment are warranted to avoid an opioid crisis in Korea. Above all, thorough knowledge for physicians and patients is urgently needed.

Keyword

Analgesics, opioid; Opium dependence; Addiction medicine; Drug-related side effects and adverse reactions; 아편유사제; 약물의존; 약물중독; 약물 관련 부작용 및 유해반응