From the Guidelines
The risk factors for opioid abuse include psychiatric comorbidities, current or past substance use, and social environments encouraging misuse, but the exception in this list is not explicitly stated as "history of use" is indeed a relevant contextual factor, especially when considering the role of parents in administering opioid analgesics to their child for pain management, as indicated by studies such as 1. However, a more accurate interpretation of the question suggests that "history of use" is not the exception, but rather, it is a part of the current or past substance use history. The correct exception is actually not listed, but based on the provided evidence, it can be inferred that the exception might be related to the fact that not all individuals with a history of opioid use will develop opioid use disorder, and the risk factors mentioned are not exhaustive. Psychiatric conditions like depression, anxiety, or personality disorders significantly increase vulnerability to opioid misuse as individuals may self-medicate emotional distress, as supported by studies such as 1 and 1. Current or past substance use disorders demonstrate a neurobiological predisposition to addiction that extends across substances. Social environments where drug misuse is normalized or encouraged create accessibility and remove protective social barriers against misuse. Healthcare providers should screen for these specific risk factors before prescribing opioids and implement additional monitoring and support for patients with these vulnerabilities to prevent the development of opioid use disorder, as recommended by guidelines and studies such as 1. Some key points to consider include:
- Psychiatric comorbidities, such as depression and anxiety, increase the risk of opioid misuse, as indicated by 1.
- Current or past substance use disorders are also risk factors for opioid misuse, as supported by 1.
- Social environments that encourage drug misuse can contribute to the development of opioid use disorder, as suggested by 1.
- Healthcare providers should be aware of these risk factors and take steps to mitigate them, such as screening for psychiatric comorbidities and substance use disorders, and providing additional monitoring and support for patients with these vulnerabilities, as recommended by 1.
From the FDA Drug Label
Risks are increased in patients with a personal or family history of substance abuse (including drug or alcohol addiction or abuse) or mental illness (e.g., major depression). Patients at high risk of buprenorphine hydrochloride abuse include those with a history of prolonged use of any opioid, including products containing buprenorphine, those with drug or alcohol abuse, or those who use buprenorphine hydrochloride in combination with other abused drugs. The answer is social environments encouraging misuse.
- The FDA drug label mentions that risks for opioid abuse include a personal or family history of substance abuse, mental illness, history of prolonged use of any opioid, drug or alcohol abuse, and use of buprenorphine hydrochloride in combination with other abused drugs 2, 2, 2.
- However, it does not explicitly mention social environments encouraging misuse as a risk factor.
From the Research
Risk Factors for Opioid Abuse
The following are risk factors for opioid abuse:
- Psychiatric comorbidities: Patients with untreated psychiatric disorders are at a higher risk of opioid misuse or addiction 3, 4, 5
- Current or past substance use: A history of substance abuse is a significant risk factor for opioid misuse or addiction 3, 6, 4
- History of use: Patients with a history of opioid use are at a higher risk of developing opioid use disorder 4
- Social environments encouraging misuse: Social or family environments that encourage misuse can contribute to the development of opioid use disorder 3, 6
Exceptions
None of the provided options are exceptions to the risk factors for opioid abuse. All the options listed, including psychiatric comorbidities, current or past substance use, history of use, and social environments encouraging misuse, are recognized risk factors for opioid abuse 3, 6, 4, 5.