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Iatrogenic addiction or dependence as a result of prescription oxycodone use in persons with chronic noncancer pain: A systematic review

Megan Dol, BSc, Mark Oremus, PhD


Objective: To determine the incidence of addiction and dependence in persons with chronic noncancer pain (CNCP) who are treated with oxycodone.

Design: Systematic review following PRISMA guidelines.

Methods: PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Library were searched from inception to January 2020. Of 1,320 retrieved citations screened by two independent raters at title and abstract and full-text screening, six articles fulfilled the eligibility criteria for the systematic review. Data extraction and risk of bias assessment followed article screening. The Cochrane Collaboration tool and the Newcastle-Ottawa Scale (NOS) were used to assess the risk of bias in individual studies.

Results: Two of the six articles reported addiction and the remaining four reported dependence. The incidence rates of addiction were 2.91 percent and 1.72 percent, and the incidence rates of dependence were 0.00 percent, 0.44 percent, 0.45 percent, and 5.77 percent. In all articles, addiction and dependence were treated as secondary outcomes. Three randomized controlled trials (RCTs) had follow-up lengths of less than 31 days, which is insufficient to assess the incidence of addiction or dependence.

Conclusions: The results of this systematic review show that oxycodone use leads to addiction and dependence in a small proportion of individuals with CNCP. However, one must exercise caution when drawing conclusions from the six included articles. Future studies in the area should examine addiction and dependence as primary outcomes using adequate follow-up periods.


chronic noncancer pain, oxycodone, addiction, opioid use disorder, dependence, opioid withdrawal syndrome

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