Socioeconomic risk factors for long‐term opioid use: A national registry‐linkage study

Abstract

BackgroundOpioid use has increased substantially as a treatment for chronic pain, although harms from long‐term opioid therapy outweigh the benefits. More knowledge about factors associated with long‐term opioid use is needed. We aimed to investigate the association between socioeconomic status and long‐term opioid use in the period 2010–2019.MethodsThis was a nested case–control study in which the cases were all persons ≥18 years with long‐term opioid use, that is use of opioids for more than 3 months (N = 215,642). Cases were matched on gender, age and index year (first long‐term use period) with four controls who filled at least one opioid prescription, but never developed long‐term opioid use in the study period (N = 862,568). We performed a logistic regression analysis adjusted for relevant confounders, stratified on age groups (18–67 years and 68 years and above).ResultsIn the younger age group, long‐term opioid use was associated with low education (adjusted odds ratio, aOR = 1.54; 95% confidence interval, CI [1.51–1.57]), low income (1.33 [1.31–1.36]), being unemployed (1.40 [1.38–1.42]) and receiving disability pension (1.36 [1.33–1.38]). Weaker associations were found for living in a single‐person household or in a dense geographical area. Similar associations were found for the older age group.ConclusionWe found that low socioeconomic status was associated with long‐term opioid use both among people in working age and older people. These results indicate a need for social and financial support for non‐pharmacological treatment of chronic pain among people with lower socioeconomic status.SignificanceThis study shows that people with low socioeconomic status are at higher risk of developing long‐term opioid use. In the clinical setting, physicians should consider socioeconomic status when prescribing opioids for chronic pain. Non‐pharmacological treatment options funded by public health services should be prioritized to those with low socioeconomic status as long‐term opioid use in chronic pain patients is not recommended.

Childhood trauma and the use of opioids and other prescription analgesics in adolescence and young adulthood: The HUNT Study

“…A recent study on adults in Norway found that socioeconomic factors remain strongly associated with long-term opioid use, also when accounting for pain conditions and mental health diagnoses. 52 Our finding that childhood trauma exposure was associated with higher analgesics prescription rates after adjustment for socioeconomic factors could indicate that the higher prevalence of childhood trauma among children growing up with a lower socioeconomic status is a driving force behind the observed higher risk of long-term opioid use in this group.…”

“…Socioeconomic factors increasing risk of trauma exposure may also increase risk of receiving long-term opioid prescriptions. 52 Despite national variations in prescription practices, it is observed that patients with psychosocial problems receive more opioid prescriptions than individuals without such problems. 13 , 58 , 62 This study was conducted in Norway, where prescription rates for opioids are generally low 33 and health care is accessible and affordable.…”

Opioid trends and risk factors for sustained use among children and adolescents in Israel: a retrospective cohort study

“…Similarly, SES and place of residency were univariately associated with sustained opioid use, but these associations were nullified in the multivariable analysis. Low SES is known to be positively associated with sustained use in adults, 1,8,36,39 but most studies in children and adolescents on sustained opioid use do not include SES as a variable. 4,16,48 Nonetheless, a recent study, performed in children and young adults with kidney stones, found sociodemographic factors to be unrelated to sustained use.…”