Table 1.

A short overview of risk factors for opioid inappropriate use (Pergolizzi et al., 2012).

Factor	Considerations	Comments
Alcohol use	Present use, inappropriate use, and alcoholism are risk factors as is recent history of alcohol abuse (Ives et al., 2006).	CAGE assessment is a simple and useful tool (Parsons et al., 2008).
Cocaine use	Present or recent history of this drug is a strong predictor of opioid inappropriate use (Ives et al., 2006).	A history of substance abuse more than five years in the past is not associated with opioid inappropriate use (Passik et al., 2011).
Substance abuse (other)	Includes marijuana, stimulants, legal, and illicit drugs (Ives et al., 2006).	Benzodiazepines in particular are associated with opioid inappropriate use (Skurtveit et al., 2010). Thus, among patients with a history of drug abuse, risk can be stratified by type of drug (cocaine and benzodiazepines are higher risk than marijuana, for example).
Family history of substance abuse	May be a risk factor even if the patient does not abuse substances himself (Prasant et al., 2006).	Applies to first-degree relatives only.
Current prescription for opioids	Long-term use of opioids is a risk factor for inappropriate use (Edlund et al., 2007).
Mental health and mood disorders	Includes dissociative disorders, bipolar disorders, depression, schizophrenia, post-traumatic stress disorders, and others (Pergolizzi et al., 2012).	Mental health disorders are prevalent among those with chronic pain syndromes (Manchikanti et al., 2002).
Gambling addiction	Gambling addiction has been associated as a risk for opioid inappropriate use (Petry et al., 2005).
Legal problems	In particular, history of drunk driving, drug convictions, or motor vehicle collisions (Turk et al., 2008).
Trauma	Being a victim of a crime or abuse (Khoury et al., 2010; Vaughn et al., 2010).	Sexual abuse in childhood is a risk for both sexes but the risk is higher for women (Kendler et al., 2000).
Young age	Younger individuals are at greater risk for opioid inappropriate use than older people (Manchikanti et al., 2006).	Age at first exposure to opioids may be a risk factor (risk is greater for younger exposure; Becker et al., 2008) and should be considered in addition to the patient's current age.