Predictors of opioid misuse in patients with chronic pain: a prospective cohort study

Abstract

Background: Opioid misuse can complicate chronic pain management, and the non-medical use of opioids is a growing public health problem. The incidence and risk factors for opioid misuse in patients with chronic pain, however, have not been well characterized. We conducted a prospective cohort study to determine the one-year incidence and predictors of opioid misuse among patients enrolled in a chronic pain disease management program within an academic internal medicine practice.

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

“…However, the ORs suggesting more opioid misuse in black and Hispanic patients were small and likely could be explained by factors not accounted for in our analysis (eg, differences in coding practices between different types of hospitals, poverty, homelessness, health literacy). In agreement with data from the primary care and interventional pain management settings [28,34], high-risk use of opioids was more common in younger patients. Our finding that male sex was associated with opioid abuse and dependence is consistent with prior research using claims data to identify patients at risk for inappropriate opioid use [46,55].…”

Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain

“…[7][8][9]13 Several patient characteristics have been associated with an increased risk of opioid misuse in observational studies. Younger age has been consistently associated with opioid misuse, [14][15][16][17][18] with more than 70% of opioid overdose deaths occurring in individuals under age 45. 19 Patients with a history of drug abuse or dependence have an increased risk of prescription opioid abuse or dependence 15 and up to six times greater risk of aberrant medication-related behaviors such as prescription forgery or obtaining opioids from lay persons.…”

Chronic Opioid Therapy Urine Drug Testing in Primary Care: Prevalence and Predictors of Aberrant Results

“…43 Currently, 20 states (including Washington) plus the District of Columbia allow marijuana for medical use, and two states (including Washington) have legalized its recreational use. Associations have been reported between marijuana use and physical and mental health problems, 45 and between UDT detection of THC and opioid misuse, 23 but little is known concerning marijuana's effects on COT patient safety and outcomes. This is an important priority for future research.…”

“…Non-prescribed opioids (detected in 5 % of UDTs) were more common among patients under the age of 45, consistent with previous findings of greater illicit drug use and opioid abuse among younger adults. 18,[22][23][24][25][26][27][28][29] Excessive days' supply of prescribed opioids was also a risk factor, suggesting the importance of prescriber attention to total days' supply of prescribed opioids. The odds of having a non-prescribed opioid detected were over twice as great for African-Americans as for whites; further research is needed to explore possible reasons.…”