Risks for opioid abuse and dependence among recipients of chronic opioid therapy: Results from the TROUP Study

Abstract

Objective-To estimate the prevalence of and risk factors for opioid abuse/dependence in longterm users of opioids for chronic pain, including risk factors for opioid abuse/dependence that can potentially be modified to decrease the likelihood of opioid abuse/dependence, and non-modifiable risk factors for opioid abuse/dependence that may be useful for risk stratification when considering prescribing opioids.Methods-We used claims data from two disparate populations, one national, commercially insured population (HealthCore) and one state-based, publicly insured (Arkansas Medicaid). Among users of chronic opioid therapy, we regressed claims-based diagnoses of opioid abuse/dependence on patient characteristics, including physical health, mental health and substance abuse diagnoses, sociodemographic factors, and pharmacological risk factors.Results-Among users of chronic opioid therapy, 3% of both the HealthCore and Arkansas Medicaid samples had a claims-based opioid abuse/dependence diagnosis. There was a strong inverse relationship between age and a diagnosis of opioid abuse/dependence. Mental health and substance use disorders were associated with an increased risk of opioid abuse/dependence. Effects of substance use disorders were especially strong, although mental health disorders were more common. Concerning opioid exposure; lower days supply, lower average doses, and use of Schedule III-IV opioids only, were all associated with lower likelihood of a diagnosis of opioid abuse/dependence. Conclusion-Opioid abuse and dependence are diagnosed in a small minority of patients receiving chronic opioid therapy, but this may underestimate actual misuse. Characteristics of the patients and of the opioid therapy itself are associated with the risk of abuse and dependence.

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

“…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.…”

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

“…3,[38][39][40][41][42][43] When a patient endorses pain, the physician must first determine the etiology of the pain and then decipher if the patient has risk factors for aberrant opioid use. The physician must then identify an appropriate treatment strategy for pain control, which may or may not include opioids.…”

Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

“…[1][2][3][4][5][6] This has occurred despite limited evidence demonstrating opioid efficacy for chronic, non-cancer pain 7,8 and evidence of their risks, including side effects, 3 and potential for abuse and dependence. 9,10 Guidelines recommend careful consideration of risks and benefits of treatment when initiating opioids for pain, especially for populations with a history of substance use disorders. 11 Prescribing opioid analgesics to HIV-infected patients, who have both a higher underlying prevalence of substance use disorders and pain conditions, is complicated.…”