This study shows that severe dependence occurs with oral opioids, although it is important to recognize that a great number of patients present with many other substance use disorders, including multiple drug use. Almost 80% of patients in this study met DSM-III-R criteria for severe dependence (ie, met at least seven criteria), and 43% met all nine criteria. Function was substantially impaired in these patients, who had major problems associated with their substance use disorders, such as the need for hospital admission for treatment and high unemployment rates. Thus, severe dependence on opioids is not limited to heroin abuse and dependence, although most research efforts to date have concentrated in the area of abuse and dependence on illicit opioids . In addition, although only a minority of chronic oral opioid users become dependent on these buy diabetes drugs, recent studies show that up to 27% of chronic oral opioid users describe ‘problems’ directly related to continuous drug use , particularly chronic constipation, depressive symptomology and drug-induced headaches.

Another finding of this study is that patients admitted to hospital with severe oral opioid dependence have a substantial history of lifetime and concurrent psychoactive substance use disorders. Thus, these patients are part of a population of multiple drug abusers or patients with substantial histories of other drug problems. Forty per cent of patients had opioid substance use disorder as their first substance use disorder; however 38% of these patients reported an alcohol, cannabis (14%) or other substance use disorder (9%) before developing an opioid substance use disorder. In many cases, patients reported beginning oral use of opioids for the treatment of pain, headaches and anxiety. The majority (71%) of patients included in this study used and had used prescription or over-the-counter drugs exclusively as their opioids. This is consistent with the literature that suggests that oral opioid addicts usually present initially with acute or chronic pain . In this respect, this group represents a population that may be different from heroin addicts who usually obtain their opioids from illicit sources and are intravenous or intranasal users.