L'Information Psychiatrique
MENUDrug dependence induced by a prescription for long-term opiate treatment : reflection on two cases Volume 94, issue 10, Décembre 2018
- Key words: clinical case, pain, opioid, iatrogenic disease, drug dependence, therapeutic withdrawal, substitution treatment, psychotherapy
- DOI : 10.1684/ipe.2018.1887
- Page(s) : 841-9
- Published in: 2018
Introduction : Concerning two patients, we are studying the drug dependence induced by the prescription of Level III opioid analgesics.
Observation : Referred to the ELSA team at the Institut Mutualiste Montsouris, in Paris, for difficulties in withdrawing from opioid treatment, these patients presented clinical manifestations suggestive of a substance use disorder despite that they were only therapeutic doses.
Discussion : The scientific literature is disparate as to the risk of developing dependency following the prescription of opiates. Screening and surveillance tools have been developed to identify these situations. These two patients were not considered at risk, hence the hypothesis of emotional dependence. In one of the situations, the differential diagnosis of pseudo-addiction may be questioned.
Specific point : In view of the lack of consensus on the management of these patients, and after a failure of opioid withdrawal, the implementation of substitution treatment was decided, as well as psychotherapeutic work.
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