Risk Factors for Misuse of Prescribed Opioids: A Systematic Review and Meta-Analysis

Abstract

Increasing opioid prescribing has been linked to an epidemic of opioid misuse. Our objective is to synthesize the available evidence about patient-, prescriber-, medication-, and system-level risk factors for developing misuse among patients prescribed opioids for noncancer pain.Methods: We performed a systematic search of the scientific and gray literature for studies reporting on risk factors for prescription opioid misuse. Two reviewers independently reviewed titles, abstracts, and full texts; extracted data; and assessed study quality. We excluded studies with greater than 50% cancer patients, palliative patients, and illicit opioid initiation. When possible, we synthesized the effect sizes of dichotomous risk factors and their associations with opioid misuse, using inversevariance random-effects meta-analysis. We calculated the mean difference between opioid misusers and nonmisusers for continuous risk factors. When studies lacked homogeneity, we synthesized their results qualitatively.Results: Of 9,629 studies, 65 met our inclusion criteria. Among patients with outpatient opioid prescriptions, the following factors were associated with the development of misuse: any current or previous substance use (odds ratio [OR] 3.55; 95% confidence interval [CI] 2.62 to 4.82), any mental health diagnosis (OR 2.45; 95% CI 1.91 to 3.15), younger age (OR 2.19; 95% CI 1.81 to 2.64), and male sex (OR 1.23; 95% CI 1.10 to 1.36). Conclusion:Although clinicians should endeavor to offer alternative pain management strategies to all patients, those who are younger, are male patients, and report a history of or current substance use or mental health diagnoses were associated with a greater risk of developing opioid misuse. Clinicians should consider prioritizing alternative pain management strategies for these higher-risk patients.

Correlates of indicators of potential extra‐medical opioid use in people prescribed opioids for chronic non‐cancer pain

“…Characteristics associated with engagement in indicators of potential extra‐medical opioid use included being younger, male and having a lifetime history of pharmaceutical opioid or illicit SUDs. This is consistent with two recent systematic reviews on the risk factors for prescription opioid misuse and addiction among people with CNCP. Additionally, the identification of these risk factors for indicators of potential extra‐medical opioid use supports clinical guidelines , which suggest careful monitoring of people with substance use histories in management of CNCP with opioids.…”

“…Monitoring of indicators of potential extra‐medical opioid use is important because they may indicate problems with pain management and are potentially associated with adverse clinical outcomes . Two recent systematic reviews examined the characteristics associated with ‘opioid misuse’ and opioid addiction . Both reviews identified similar significant associations, such as a history of substance use .…”

“…Two recent systematic reviews examined the characteristics associated with ‘opioid misuse’ and opioid addiction . Both reviews identified similar significant associations, such as a history of substance use . Although the correlates of opioid misuse and addiction in people prescribed opioids for pain are well‐documented, less is known about the wider range of behaviours defined as indicators of potential extra‐medical opioid use.…”

The Trends in Opioid Use in Castile and Leon, Spain: A Population-Based Registry Analysis of Dispensations in 2015 to 2018

“…Furthermore, the use of opioids increased as age increased, which is easily understood because the disease burden increases as age increases. It should be taken into account that the misuse of psychoactive substances (mostly illegally obtained) is prevalent among young male users [24]. This fact may be the explanation for the differences between Europe and America concerning death due to opioid misuse, which is particularly common among middle-aged individuals in America [6].…”

Verordnungshäufigkeit, Missbrauch und Abhängigkeit von Benzodiazepinen, Z-Substanzen und Opioidanalgetika

“…Der bedeutsamste Risikofaktor für die Entstehung einer OA-Abhängigkeit ist eine frühere Suchterkrankung, bereits eine positive Familienanamnese erhöht die Wahrscheinlichkeit [60,62,65,84].…”