Review Article

Designing Opioids That Deter Abuse

Table 2

Definitions.

Aberrant drug-related behaviors: behaviors that depart or deviate from strict adherence to the prescribed therapeutic regimen set forth by a physician. Some examples include [9, 20] (list is not exhaustive)
(i) Forging prescriptions
(ii) Stealing or borrowing drugs
(iii) Multiple episodes of loss or theft of prescription drugs
(iv) Not following prescribed dose and schedule on several occasions
(v) Using prescribed drugs before expected renewal date
(vi) Injecting or snorting opioids
(vii) Multiple unauthorized dose increases (self-escalating)
(viii) Obtaining drugs from friends, family, street, and others
(ix) Repeatedly seeking drugs from other providers or emergency rooms
(x) Concurrent use of illicit drugs (e.g., heroin, cocaine, methamphetamine, marijuana, and others)
(xi) Concurrent use of alcohol
(xii) Past history of abuse of prescription medications, and possibly street drugs
(xiii) Requests for specific drugs, especially a preference for immediate release over sustained release preparations
(xiv) Increase in anxiety, sleep disturbance, or depression
(xv) Urine drug test positive for illicit drugs or unauthorized drugs
(xvi) Doctor shopping
(xvii) Persistent oversedation or euphoria
(xviii) Appearing intoxicated
(xix) Deterioration of function at work, in the family, or socially
(xx) Decrease in physical, psychological, or social function
(xxi) Noncompliance with nonopioid components of pain treatment
(xxii) Reporting no effect from nonopioids, especially antidepressants
(xxiii) Noncompliance with nondrug components of pain treatment (psychotherapy, PT, etc.)
(xxiv) Accidents: motor vehicle, falls, and others

Addiction: addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social, and spiritual manifestations [21].

Substance abuse: a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by one (or more) of the following, occurring within a 12-month period [22].
 (1) Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; or neglect of children or household).
  (2) Recurrent substance use in situations in which it is physically hazardous (such as driving an automobile or operating a machine when impaired by substance use).
  (3) Recurrent substance-related legal problems (such as arrests for substance-related disorderly conduct).
  (4) Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication and physical fights).

Dependence: physical dependence isa state of adaptation that is manifested by a drug class-specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist [23].