Analgesic Opioid Misuse and Opioid Use Disorder among Patients with Chronic Non-Cancer Pain and Prescribed Opioids in a Pain Centre in France

Abstract

(1) Background: Chronic non-cancer pain (CNCP) remains a public health challenge around the world. Opioids (PO) have been increasingly used in the treatment of CNCP in the last 20 years. This study aimed to assess the prevalence of opioid misuse and prescribed-opioid use disorder (p-OUD) among patients with CNCP in a pain centre in France, and to analyse risk factors for moderate or severe p-OUD. (2) Method: A cross-sectional study was conducted, including patients consulting for pain management in the pain centre of Brest University Hospital. A self-questionnaire was administered (sociodemographic data, medical data, PO misuse, and p-OUD according the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) criteria). Descriptive, univariate, and multivariate analyses were conducted, together with a principal component analysis, in order to identify factors associated with p-OUD. (3) Results: In total, 115 patients were included, the majority of whom were women, with a mean age of 52 years old [18–82]; 64.3% (n = 74) had a current prescription for opioid analgesics (weak or strong). In this group, 56.7% (n = 42) had no or only mild p-OUD and 43.3% (n = 32) had current moderate or severe p-OUD. Patients with moderate or severe p-OUD were more likely to have a current antidepressant prescription, to have had psychotherapy, to currently use strong opioids and oxycodone, and to report taking more frequent doses than prescribed and feeling dependent. (4) Conclusions: We showed that the prevalence of current moderate/severe p-OUD concerned 43.3% of the patients with a CNCP seeking treatment in a pain centre. According to these results, several measures are relevant in managing p-OUD among patients with CNCP.

Cross-sectional study of the prevalence of prescription opioids misuse in French patients with chronic non-cancer pain: An update with the French version of the POMI scale

“…No study has specifically assessed the prevalence of POM with the POMI scale, making it difficult to compare our results with the literature. Nevertheless, two French studies assessing OUD with the DSM-5 (not validated in French) showed a prevalence from 43% to 52% (Eiden et al, 2019;Guillou-Landreat et al, 2021), 26.5% in a German study (Just et al, 2019) and 34.9% in an American study (Boscarino et al, 2011). The study of Guillou-Landreat et al (Guillou-Landreat et al, 2021) also assessed POM with the POMI scale but provide no information on the percentage of POM.…”

“…Nevertheless, two French studies assessing OUD with the DSM-5 (not validated in French) showed a prevalence from 43% to 52% (Eiden et al, 2019;Guillou-Landreat et al, 2021), 26.5% in a German study (Just et al, 2019) and 34.9% in an American study (Boscarino et al, 2011). The study of Guillou-Landreat et al (Guillou-Landreat et al, 2021) also assessed POM with the POMI scale but provide no information on the percentage of POM. The reasons for the variability of prevalence between studies may be the differences in population, the scale used and methodology.…”

“…A margin of error on the estimate is defined to estimate the number of participants required, in addition to the expected proportion of chronic pain subjects with misuse. Thus, according to the literature, for an expected proportion of misuse subjects of about 40% ( Vowles et al, 2015 ; Guillou-Landreat et al, 2021 ), the inclusion of at least 577 subjects was necessary to obtain an accuracy for this proportion equals to ±4%. For 1,025 subjects this accuracy was ±3%.…”

“…A French study highlighted a higher prevalence with 52% of opioids misuse, assessed by DSM-5 criteria ( Eiden et al, 2019 ). Another recent French study found 43.3% of patients with CNCP had current moderate or severe DSM-5 criteria ( Guillou-Landreat et al, 2021 ). However, these studies used the DSM-5 dimensional diagnosis of substance use disorder to assess misuse.…”

An Italian Expert Consensus on the Use of Opioids for the Management of Chronic Non-Oncological Pain in Clinical Practice: Focus on Buprenorphine.

“…In the UK, it has been estimated that nearly one million people are using some form of opioid; in France prescription opioid use between 2004 and 2017 at least doubled. 8 In Italy, an almost four-fold increase in opioid prescriptions has been documented between 2007 and 2015, potentially correlated to the observed reduction in the prescription of NSAIDs. 5 The most impactful consequences of long-term opioid treatment are the development of tolerance, physical and mental addiction and the potential risk of incurring a substance use disorder (SUD).…”