Adverse Selection? A Multi-Dimensional Profile of People Dispensed Opioid Analgesics for Persistent Non-Cancer Pain

Abstract

ObjectivesThis study investigates utilisation patterns for prescription opioid analgesics in the Australian community and how these are associated with a framework of individual-level factors related to healthcare use.MethodsSelf-reported demographic and health information from participants in the 45 and Up Study cohort were linked to pharmaceutical claims from 2006–2009. Participants comprised 19,816 people with ≥1 opioid analgesic dispensing in the 12-months after recruitment to the cohort and 79,882 people not dispensed opioid analgesics. All participants were aged ≥45 years, were social security pharmaceutical beneficiaries, with no history of cancer. People dispensed opioid analgesics were classified as having acute (dispensing period <90 days), episodic (≥90 days and <3 ‘authority’ prescriptions for increased quantity supply) or long-term treatment (≥90 days and ≥3 authority prescriptions).ResultsOf participants dispensed opioid analgesic 52% received acute treatment, 25% episodic treatment and 23% long-term treatment. People dispensed opioid analgesics long-term had an average of 14.9 opioid analgesic prescriptions/year from 2.0 doctors compared with 1.5 prescriptions from 1.1 doctors for people receiving acute treatment. People dispensed opioid analgesics reported more need-related factors such as poorer physical functioning and higher psychological distress. Long-term users were more likely to have access-related factors such as low-income and living outside major cities. After simultaneous adjustment, association with predisposing health factors and access diminished, but indicators of need such as osteoarthritis treatment, paracetamol use, and poor physical function were the strongest predictors for all opioid analgesic users.ConclusionsPeople dispensed opioid analgesics were in poorer health, reported higher levels of distress and poorer functioning than people not receiving opioid analgesics. Varying dispensing profiles were evident among people dispensed opioid analgesics for persistent pain, with those receiving episodic and long-term treatment dispensed the strongest opioid analgesics. The findings highlight the broad range of factors associated with longer term opioid analgesics use.

Survey of Pain Therapies in Marfan Syndrome

“…Extant literature documents that opioid users report severe pain [64], and have higher healthcare utilization compared with non-opioid users [38,65,66]. Our findings suggest that similarly to other chronic pain conditions, MFS individuals who use opioids report more intense, frequent, and non-remitting pain.…”

Associations of borderline personality with pain, problems with medications and suicidality in a community sample of chronic non-cancer pain patients prescribed opioids for pain

“…The complexity of the chronic pain patient, in terms of multiple social, mental health and physical wellbeing issues (14,40), makes treatment complicated. With the addition of BPD, which has often been associated with a 'difficult patient' (9) treatment can become more…”

Factors associated with the development of depression in chronic non-cancer pain patients following the onset of opioid treatment for pain

“…The current study aimed to identify factors associated with depression developing after the commencement of opioid medications that might differ from those associated with the onset of pain itself. Where previous research has been limited by measuring opioid use through prescriptions or specific populations (Rogers et al, 2013;Scherrer et al, 2014), the current study is unique in using a community sample self-reporting consumption of opioids, including those purchased over the counter, and additionally controlling for pain-related factors.…”

“…A recent cohort study found individuals who were receiving opioid treatment were more likely to report high levels of psychological distress compared with individuals not receiving opioid medications (Rogers et al, 2013). Additionally, opioid-naïve patients with chronic pain without a recent history of depression have been found to be at greater risk of developing depression the longer they were taking opioid medications (Scherrer et al, 2014).…”