The association of tobacco use with prescription of muscle relaxants, benzodiazepines, and opioid analgesics for non‐cancer pain

Abstract

Background and ObjectivesTobacco use and co‐prescription of sedative hypnotics are risk factors for misuse of prescribed opioids among patients with non‐cancer pain. However, the association between tobacco use and these co‐prescriptions has not been clarified. We aimed to assess differences in the prescription and co‐prescription rates of opioid analgesics with muscle relaxants and/or benzodiazepines between tobacco users and non‐users.MethodsVisit data were obtained from the 2006 to 2009 National Ambulatory Medical Care Survey, an annual cross‐sectional survey of visits to office‐based physicians in outpatient settings in the United States. Our sample patients were aged ≥18 years and diagnosed with non‐cancer back and neck pain. The χ2 test and multiple logistic regression analysis were used to assess bivariate and multivariate associations between prescription or co‐prescription rates and tobacco use status.ResultsWe analyzed a total of 114,199,536 weighted visits (unweighted number: 3,521). Significant odds ratios (ORs) of tobacco users (vs non‐users) for medical prescriptions were as follows: opioid analgesics, OR 2.14, 95% confidence interval (CI) 1.64–2.80; muscle relaxants and opioid analgesics, OR 2.57, 95%CI 1.76–3.74; benzodiazepines and opioid analgesics, OR 3.66, 95%CI 2.11–6.35, and muscle relaxants, benzodiazepines, and opioid analgesics, OR 7.02, 95%CI 2.98–16.57.Conclusions and Scientific SignificanceTobacco users were more likely to receive prescriptions for opioid analgesics with muscle relaxants and/or benzodiazepines than non‐users. Healthcare professionals need to limit co‐prescription of opioid analgesics with muscle relaxants and/or benzodiazepines among tobacco users and provide a comprehensive approach to pain management. (Am J Addict 2019;XX:1–8)

Consensus statement on smoking cessation in patients with pain

“…Since both tobacco and opioid analgesics are dependent substances that activate the brain reward system, the use of opioid analgesics in current or former smokers is often a topic of scientific discussions. Previous reports indicated that smokers had more high risk for prevalence rates of opioid analgesic use [ 120 – 122 ], opioid analgesic use consumption [ 84 , 111 , 123 , 124 ], and opioid use disorders [ 104 , 122 , 124 , 125 ], compared with nonsmokers.…”

Real-World Evidence in Prescription Medication Use Among U.S. Adults with Neck Pain

“…Thus, healthcare professionals should encourage health education, especially for the patient populations mentioned above, and recommend non-pharmaceutical therapy, including exercise, manual therapy, and psychological therapy, as the first-line treatment. Takaki et al reported that tobacco users were more likely than non-users to use opioid analgesics in combination with/without muscle relaxants and/or benzodiazepines for non-cancer pain [52]. Thus, healthcare professionals also should consider limiting opioid use by tobacco users.…”