Factors associated with prescription opioid misuse in a cross-sectional cohort of patients with chronic non-cancer pain

Hah, Jennifer M.; Sturgeon, John A.; Zocca, Jennifer; Sharifzadeh, Yasamin; Mackey, Sean

doi:10.2147/jpr.s131979

Cited by 39 publications

(43 citation statements)

References 33 publications

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“…The study sample included mostly female (71.4%), married (53.6%), and middle‐aged adults (mean = 44.20, SD = 12.85) who were mainly White/non‐Hispanic (60.7%), followed by Hispanic/Latino (17.9%) and Asian (8.9%). The current sample's demographics are similar to those in our previous studies, which included large patient samples . About 23.2% reported their chronic pain conditions were associated with traumatic life events.…”

Section: Resultssupporting

confidence: 67%

“…A predominantly female sample limits generalizability of the findings to male patients. However, because patients visiting an outpatient pain clinic are mostly female (about 63%), our findings may be generalizable to patients seeking medical treatments for chronic pain. Additionally, our sample included patients with heterogeneous pain conditions and therefore was not representative of patients with any specific pain conditions.…”

Section: Discussionmentioning

confidence: 90%

“…The current sample's demographics are similar to those in our previous studies, which included large patient samples. 29,30 About 23.2% reported their chronic pain conditions were associated with traumatic life events. About 50% of patients reported their pain duration to be <6.5 years (interquartile range = 2.4-17.0 years), and up to 50% of patients received 2 International Statistical Classification of Diseases and Related Health Problems (10th revision) (ICD-10) diagnoses associated with their pain.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Candidate Items for Severe PTSD Screening for Patients With Chronic Pain: Pilot Data Analysis With the IRT Approach

et al. 2019

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Objectives Post‐traumatic stress disorder (PTSD) commonly co‐occurs with chronic pain. Although PTSD symptoms are associated with negative health outcomes in patients with chronic pain, PTSD is typically under‐detected and under‐treated in outpatient pain settings. There is a need for rapid, brief screening tools to identify those at greatest risk for severe PTSD symptoms. To achieve that goal, our aim was to use item response theory (IRT) to identify the most informative PTSD symptoms characterizing severe PTSD in patients with chronic pain. Methods Fifty‐six patients (71% female, 61% White) with mixed etiology chronic pain completed the PTSD Checklist‐Civilian Version (PCL‐C) as part of their appointment with a pain psychologist at a tertiary outpatient pain clinic. We used an IRT approach to evaluate each item's discriminant (a) and severity (b) parameters. Results Findings revealed that “feeling upset at reminders” (a = 3.67, b = 2.44) and “avoid thinking or talking about it” (a = 3.61, b = 2.17) as being highly discriminant for severe PTSD. Conclusions We identified 2 candidate items for a brief PTSD screener as they were associated with severe PTSD symptoms. These 2 items may provide clinical utility in outpatient pain treatment settings to identify those suffering from severe PTSD, enabling physicians to refer them to trauma‐specific evaluation or therapy. Future research is needed to further validate and confirm these candidate PTSD items in a larger clinic sample. Lay Summary The current study used the IRT approach to identify candidate items for a brief screener for severe PTSD. We examined 17 items of the PCL‐C, and identified 2 items that were highly discriminant for severe PTSD. The 2 items were “feeling upset at reminders” and “avoid thinking or talking about it.” These 2 items may provide clinical utility, since they may enable physicians to screen and make a referral for further assessment or treatment for PTSD.

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Section: Resultssupporting

confidence: 67%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Evaluation of Candidate Items for Severe PTSD Screening for Patients With Chronic Pain: Pilot Data Analysis With the IRT Approach

et al. 2019

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“…After pain, insomnia (43%) and stress (42%) were the second and third most commonly reported motivations for therapeutic cannabis use among daily cannabis users. The inability to fall asleep and the inability stay asleep are common symptoms of pain-causing conditions [44], and experiencing these symptoms increases the likelihood of opioid misuse among chronic pain patients [45]. The relationship between sleep deprivation and pain is thought to be bidirectional [44,46], suggesting that improved sleep management may improve pain outcomes.…”

Section: Discussionmentioning

confidence: 99%

Frequency of cannabis and illicit opioid use among people who use drugs and report chronic pain: A longitudinal analysis

et al. 2019

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Background Ecological research suggests that increased access to cannabis may facilitate reductions in opioid use and harms, and medical cannabis patients describe the substitution of opioids with cannabis for pain management. However, there is a lack of research using individuallevel data to explore this question. We aimed to investigate the longitudinal association between frequency of cannabis use and illicit opioid use among people who use drugs (PWUD) experiencing chronic pain. Methods and findings This study included data from people in 2 prospective cohorts of PWUD in Vancouver, Canada, who reported major or persistent pain from June 1, 2014, to December 1, 2017 (n = 1,152). We used descriptive statistics to examine reasons for cannabis use and a multivariable generalized linear mixed-effects model to estimate the relationship between daily (once or more per day) cannabis use and daily illicit opioid use. There were 424 (36.8%) women in the study, and the median age at baseline was 49.3 years (IQR 42.3-54.9). In total, 455 (40%) reported daily illicit opioid use, and 410 (36%) reported daily cannabis use during at least one 6-month follow-up period. The most commonly reported therapeutic reasons for cannabis use were pain (36%), sleep (35%), stress (31%), and nausea (30%). After adjusting for demographic characteristics, substance use, and health-related factors, daily cannabis use was associated with significantly lower odds of daily illicit opioid use (adjusted odds ratio 0.50, 95% CI 0.34-0.74, p < 0.001). Limitations of the study included self-reported measures of substance use and chronic pain, and a lack of data for cannabis preparations, dosages, and modes of administration.

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“…The risk of behaviour suggestive of opioid abuse constitutes a predictor of the development of a substance use disorder, which is a real possibility for individuals with chronic non-cancer pain and a considerable concern for health professionals. 4 Opioid use patterns of individuals with non-cancer pain are influenced by the behavioural dynamics of the individual in managing and properly following the prescription, as well as the skills of health professionals regarding the identification of risk and protection factors of opioid abuse by these individuals. 5 …”

Section: Introductionmentioning

confidence: 99%

Risk of behaviour suggestive of opioid abuse: a protocol for a systematic review of validated assessment tools

et al. 2018

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IntroductionOpioid use patterns of individuals with non-cancer pain are influenced by the behavioural dynamics of the individual in managing and properly following the prescription. The use of assessment tools for measuring the risk of behaviour suggestive of opioid abuse is important for health professionals who provide care to individuals with non-cancer pain. The aim of the proposed review is to analyse the psychometric properties of tools for measuring the risk of behaviour suggestive of opioid abuse in adults with non-cancer pain.Methods and analysisThe review process will be based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. The Consensus-Based Standards for the Selection of Health Measurement Instruments will be used to analyse the assessment tools. Two independent reviewers will perform the literature search and analysis procedures. Searches will be performed on PubMed, Web of Science, Cochrane, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases, and the ‘snowball’ strategy will be employed. The inclusion criteria will be (1) validation studies, (2) assessment tools designed exclusively for measuring the risk of behaviour suggestive of opioid abuse and (3) assessment tools designed for evaluation of adults with chronic non-cancer pain. The titles and abstracts of the studies retrieved from the databases will be analysed for the preselection of articles, which will be submitted to a full-text analysis to define the final sample. Divergence of opinion between two reviewers will be resolved by consulting a third reviewer.Ethics and disseminationThe review will offer an overview of assessment tools available for measuring the risk of behaviour suggestive of opioid abuse, which is relevant to reducing the risk of deaths due to abusive consumption and for clinical management of adults with chronic non-cancer pain.PROSPERO registration numberCRD42018081577.

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Factors associated with prescription opioid misuse in a cross-sectional cohort of patients with chronic non-cancer pain

Cited by 39 publications

References 33 publications

Evaluation of Candidate Items for Severe PTSD Screening for Patients With Chronic Pain: Pilot Data Analysis With the IRT Approach

Evaluation of Candidate Items for Severe PTSD Screening for Patients With Chronic Pain: Pilot Data Analysis With the IRT Approach

Frequency of cannabis and illicit opioid use among people who use drugs and report chronic pain: A longitudinal analysis

Risk of behaviour suggestive of opioid abuse: a protocol for a systematic review of validated assessment tools

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