Prescription opioid misuse: improving prevention and treatment

Research problem and specific questions: This project aims to prevent misuse of prescription opioid analgesics and improve interventions for people dependent on these prevalent and highly addictive narcotics, addressing knowledge gaps defined by SBU.Background: Misuse of opioid analgesics has led to widespread societal problems in the United States, including criminality, addiction, overdose, and death.

In Sweden, prescription of strong opioids has significantly increased, especially in young people. Most opioids are prescribed in primary care. Many who become addicted recover, but treatment dropout is substantial, and mortality is high.

Data are lacking on outcomes and prognostic factors needed to improve and personalize interventions.Data and method: This project connects the interventions needed to prevent and treat addiction: prevention in primary care, dosage tapering for those who develop addiction, and opioid maintenance for the most severely addicted.Study 1 is an RCT carried out at 52 primary health care centers to evaluate whether a new educational program with online feedback for GPs can reduce prescription of opioid analgesics by improving adherence to pain management guidelines in primary care.Study 2 is a prospective cohort study that follows over 400 people with prescription drug addiction to analyze outcomes and prognostic factors in tapering programs in specialized addiction care.

The primary outcome is the proportion who become drug-free as measured by verified drug tests at 6, 12, and 24 months.Study 3 is a national cohort study that follows up outcomes and prognostic factors in >6000 people in opioid maintenance programs via a unique national quality register.Plan for project realization: All three studies have successfully reached key milestones, such as ethical permission, inclusion, implementation, and data collection in primary care and addiction care.

Next steps include follow-up, data analysis, and scientific publication.Societal relevance: Study 1 has the potential to prevent addiction and increase adherence to treatment guidelines. The intervention is easy to disseminate. Study 2 evaluates current standard treatment for prescription drug addiction, which has not yet been done in Sweden.

Study 3 will examine the long-term outcomes of opioid maintenance in a national cohort.

Opioid maintenance programs have been politically controversial, and it is important to replace opinion with scientific evidence.