Characteristics of Methadone Maintenance Treatment Patients Prescribed Opioid Analgesics

Abstract

Background Opioid analgesic use and disorders have dramatically increased among the general American population and those receiving methadone maintenance treatment (MMT). Most research among MMT patients focuses on opioid analgesics misuse or disorders; few studies focus on MMT patients prescribed opioid analgesics. We describe demographic, clinical, and substance use characteristics of MMT patients prescribed opioid analgesics and compare them to MMT patients not prescribed opioid analgesics. Methods We conducted a cross-sectional secondary data analysis using screening interviews from a parent study. From 2012–2015, we recruited adults from 3 MMT Bronx clinics. Questionnaire data included: patterns of opioid analgesic use, substance use, comorbid illnesses, and demographic characteristics. Our main dependent variable was patients’ report of currently taking prescribed opioid analgesics. To compare characteristics between MMT patients prescribed and not prescribed opioid analgesics, we conducted chi-squared tests, t-tests, and Mann-Whitney U tests. Results Of 611 MMT patients, most reported chronic pain (62.0%), HCV infection (52.1%), and currently using illicit substances (64.2%). Of the 29.8% who reported currently taking prescribed opioid analgesics, most misused their opioid analgesics (57.5%). Patients prescribed (versus not prescribed) opioid analgesics were more likely to report HIV infection (aOR=1.6, 95% CI: 1.1–2.3) and chronic pain (aOR=7.6, 95% CI: 4.6–12.6). Conclusion Among MMT patients primarily in three Bronx clinics, nearly one-third reported taking prescribed opioid analgesics. Compared to patients not prescribed opioid analgesics, those prescribed opioid analgesics were more likely to report chronic pain and HIV infection. However, between these patients, there was no difference in illicit substance use. These findings highlight the complexity of addressing chronic pain in MMT patients.

Chronic Pain Opioid-Maintained Patients Receive Less Analgesic Opioid Prescriptions

“…The prevalence of AOP was lower in the CNCP OST patients compared to CNCP control patients (47.8 vs. 68.0%). We observed similar prevalence of AOP in CNCP OST patients as that reported in prior studies, where prevalence ranged between 43 and 47% ( 17 , 21 , 27 ). Furthermore, following adjustment for age, gender, low-income status, mental health disorder, HCV infection, and alcohol use disorder, our findings revealed a 2.7-fold decrease in the prevalence of AOP in CNCP OST patients compared to CNCP control patients.…”

“…Thirdly, there is wide abuse in terms of diversion associated with analgesic opioids in OST patients, where pain may be reported solely to manipulate prescribers to obtain opioid medication. An American study showed that 57.5% of analgesic opioid misuse occurred in methadone-maintained patients with chronic pain ( 21 ). Two recent studies also highlighted that the major source of diverted opioids was physician prescriptions ( 49 , 50 ).…”

“…Treating both pain and addiction proves to be a significant challenge, and caregivers commonly report that all their diagnostic and therapeutic decisions are subject to ambiguity ( 26 ). While most studies examining opioid analgesic use in OST patients have addressed opioid analgesic misuse ( 1 , 2 ), only few have specifically focused on OST patients who are prescribed analgesic opioids for chronic pain; the prevalence in this opioid-dependent population of analgesic opioid prescription (AOP) ranged from 43 to 47% ( 17 , 21 , 27 ).…”

“…Pain management in OST patients is often stressful for primary care physicians ( 28 ), and they may be wary of prescribing opioid analgesics due to the potential risks of overdose ( 3 , 29 ), diversion, and abuse ( 21 ). Inadequate AOP may both undertreat the pain and precipitate withdrawal symptoms ( 30 ).…”

Co-calibration of two self-reported measures of adherence to antiretroviral therapy

“…The first source is data from five studies within the Seek Test Treat and Retain (STTR) consortium funded by the National Institute of Drug Abuse(Chandler et al, 2015). The 5 studies included in these analyses were selected based on simultaneous collection of both adherence measures (described below) and were grouped into categories based on their study populations: criminal justice (CJ) (Carda-Auten et al, 2014; Gordon, Kinlock, McKenzie, Wilson, & Rich, 2013), international (Tomori et al, 2014; Wechsberg et al, 2014), or other vulnerable populations (VP) (Glenn et al, In press ). The second data source is the University of Washington site of the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS)(Kitahata et al, 2008) cohort, a longitudinal observational study of PLWH in primary care.…”