A Model to Identify Patients at Risk for Prescription Opioid Abuse, Dependence, and Misuse

Rice, J. Bradford; White, Alan G.; Birnbaum, Howard G.; Schiller, M.; Brown, David A.; Roland, Carl L.

doi:10.1111/j.1526-4637.2012.01450.x

Cited by 130 publications

(126 citation statements)

References 16 publications

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“…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]. The observation that patients having spinal fusion showed the highest prevalence of opioid abuse and dependence was not surprising given that opioids play an increasingly pivotal role in the long-term management of chronic back pain, which is the primary reason for patients to undergo such procedures [13,14].…”

Section: Discussionsupporting

confidence: 88%

“…The observation that patients having spinal fusion showed the highest prevalence of opioid abuse and dependence was not surprising given that opioids play an increasingly pivotal role in the long-term management of chronic back pain, which is the primary reason for patients to undergo such procedures [13,14]. Patients with mental health and nonopioid substance use disorders had greater odds of abusing or being dependent on opioids, thus confirming the generalizability of previous studies to orthopaedic surgical inpatients [16,17,46,49,55]. Quality and safety initiatives aimed at reducing opioid misuse in the orthopaedic setting should primarily target this at-risk population, and be particularly implemented at urban teaching hospitals in the Northeast and West that function as ''safety net'' providers.…”

Section: Discussionsupporting

confidence: 57%

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

Menendez

Ring

Bateman

2015

Clinical Orthopaedics &Amp; Related Research

302

176

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Background Many patients having discretionary orthopaedic surgery take opioids daily, either with a prescription or illicitly, however little is known regarding the prevalence and effect of high-risk opioid use (eg, abuse, dependence) in the perioperative orthopaedic setting. Questions/purposes We sought (1) to determine the prevalence of opioid abuse and dependence in patients undergoing major elective orthopaedic surgery; (2) to characterize the relationship of opioid abuse and dependence with in-hospital postoperative mortality and adverse events, failure to rescue, prolonged length of stay, and nonroutine disposition; and (3) to identify factors associated with high-risk opioid use.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 57%

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

Menendez

Ring

Bateman

2015

Clinical Orthopaedics &Amp; Related Research

302

176

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“…Also, while use is higher in rural areas, 40,42 attempted deception was not associated with the size of participants' home communities. Deceivers were more likely to be male, as is the case for pharmaceutical misusers more generally, 43 and our income findings mirror a previous study that noted pharmaceutical misuse was lowest within homes earning $40,000 to $75,0000 annually. 44 Although this study provides the first detailed profile of patients attempting physician deception using a random sample of young adults, it is not without limitations.…”

Section: Discussionsupporting

confidence: 80%

Deception for Drugs: Self-Reported "Doctor Shopping" Among Young Adults

Stogner

Sanders

Miller

2014

The Journal of the American Board of Family Medicine

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Background: Pharmaceutical abuse is a burgeoning problem, and various forms of drug diversion are becoming more common. At present, little is known about those who attempt to deceive physicians to receive medications, and even less is known about those who successfully avoid detection and abuse-related repercussions. The goal of this study is to assess the prevalence of attempted physician deception in a general population, explore common motives, and evaluate risk factors associated with the behavior.Methods: A stratified random sampling technique was used to obtain a locally representative sample of 2349 young adults. The sample was 48.4% male, 68.9% white, 24.4% black, and 2.8% Hispanic. Selected individuals were surveyed using a self-report instrument (80.4% response rate).Results: Of the respondents, 93 (4.0%) self-reported having attempted to deceive a physician to obtain a pharmaceutical. Most of these indicated that they were at least partially motivated by their own abuse. Approximately half reported that selling a portion of the prescription was a motivating factor. Alcohol use, marijuana use, and pharmaceutical misuse each were risk factors associated with attempted deception. Although no traits were definitively linked to the behavior, attempted deception was more commonly reported by men, Hispanics, self-identified lesbian/gay/bisexual/transgender individuals, and those at the lowest and highest extremes of the income spectrum. Logistic regression models of rare events indicated that past substance use along with sexual orientation and family income were related to attempted deception when controlling for other factors.Conclusion: Results suggest that attempted physician deception may be more common than previously believed. Practicing physicians should attempt to use risk factor information presented within this study, albeit very cautiously. This study identifies general characteristics of young people who might divert medications but notes that only a small minority of any patient group will do so. Awareness should not equal bias in the treatment of these patients; instead, it should reinforce the need for careful clinical interviewing and the utilization of prescription drug monitoring programs and local law enforcement databases. (J Am Board Fam Med 2014;27:583-593.)

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“…However, this methodology has been used in prior studies, and we do not anticipate it to be an issue. [39][40][41][42][43] Finally, patients with Medicare or Medicaid were not included in the study, as these populations are known to have higher rates of BHCs, and we wished to prevent bias between patients with versus without BHCs.…”

Section: Discussionmentioning

confidence: 99%

Point Prevalence of Co-Occurring Behavioral Health Conditions and Associated Chronic Disease Burden Among Adolescents

Kline-Simon

Weisner

Sterling

2016

Journal of the American Academy of Child & Adolescent Psych

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A Model to Identify Patients at Risk for Prescription Opioid Abuse, Dependence, and Misuse

Cited by 130 publications

References 16 publications

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

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

Deception for Drugs: Self-Reported "Doctor Shopping" Among Young Adults

Point Prevalence of Co-Occurring Behavioral Health Conditions and Associated Chronic Disease Burden Among Adolescents

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