High Fluidity of Opioid Use Behaviors Among Adults With Chronic Noncancer Pain

Some patients with cancer are prescribed unnecessary opioids.
While there are concerns about long-term prescribed opioid use among individuals with chronic noncancer pain, until now there hasn’t been a study which investigated whether the same patients engage in a risky pattern of use in the long term.

Individuals with chronic noncancer pain (CNCP) exhibited extramedical opioid behaviors, fluidity in opioid use, and opioid dependence. These findings were published in JAMA Network Open.

Individuals (N=1514) with CNCP were recruited for the POINT (Pain and Opioids in Treatment) study at community pharmacies across Australia between 2012 and 2018. Participants were interviewed at baseline, 3 months, and yearly for 5 years. Interviews comprised assessment of medication use and dosage, opioid use behaviors, and indicators of extramedical use. Each interview lasted between 60 and 90 minutes and participants were compensated AUD $40-$50 per interview.

Study participants were 44.39% men, aged mean 58 (standard deviation [SD], 19) years, 48.68% were unemployed, median time with pain was 10.00 (interquartile range [IQR], 4.54-20.00) years, and within the last 12 months the participants had a median of 2.00 (IQR, 1.00-3.00) CNCP conditions. The most frequently reported conditions were neck or back pain (79.66%) and arthritis (67.04%).

Across interviews, between 10.98%-14.73% were taking 200 mg/d oral morphine equivalents (OME), between 8.46% and 23.77% had requested a dose increase during the previous 3 months, and between 4.61% and 13.97% had asked for an early prescription renewal. Cessation of opioid increased from 9.15% (95% CI, 8.55%-9.74%) in year 1 to 20.02% (95% CI, 19.14%-20.89%) in year 5.

Few participants reported tampering (3.06%-7.86%) or diversion (0.47%-1.39%) behaviors during the previous 3 months and over half (55.26%-64.44%) did not meet the criteria for opioid dependence.

Cessation of opioids was less likely among individuals who had moderate to high Prescribed Opioids Difficulty Scale scores (odds ratio [OR], 0.02; 95% CI, 0.01-0.05), were consuming ³200 mg/d OME (OR, 0.23; 95% CI, 0.10-0.51), had ³7 Brief Pain Inventory pain interference (OR, 0.42; 95% CI, 0.28-0.63), pain self-efficacy score <30 (OR, 0.51; 95% CI, 0.34-0.76), were unemployed (OR, 0.52; 95% CI, 0.31-0.85), or retired (OR, 0.34; 95% CI, 0.34-0.82).

This study may have been biased by the representativeness of the study sample. The results may not be generalizable to patients with CNCP who have just begun using opioids.

These findings indicated individuals who used opioids for CNCP had fluidity in their opioid behaviors, likely indicating a needed for reassessment of the efficacy of opioid use among individuals over time.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference Degenhardt L, Hungerford P, Nielsen S, et al. Pharmaceutical opioid use patterns and indicators of extramedical use and harm in adults with chronic noncancer pain, 2012-2018.JAMA Netw Open. 2021;4(4):e213059. doi:10.1001/jamanetworkopen.2021.3059