Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3020 — Risk Factors for Diagnosed Opioid Abuse and Dependence among Individuals Using Opioids for Chronic Non-Cancer Pain

Edlund MJ (Little Rock-COE) , Steffick DE (Little Rock-COE), Hudson T (Little Rock-COE), Harris KM (RAND), Sullivan M (University of Washington)

A central question in prescribing opioids for chronic non-cancer pain (CNCP) is how to best balance the risk of opioid abuse and dependence with the benefits of pain relief. To achieve this balance, clinicians need an understanding of the risk factors for opioid abuse, an issue that is only partially understood. To help fill this research gap, we investigated risk factors associated with opioid abuse among VA patients using opioids chronically for CNCP.

We conducted a secondary data analysis of VISN 16 longitudinal administrative data (years 2002-2005) for chronic users of opioids for CNCP (n=15,390) to investigate risk factors for the development of diagnosed opioid abuse or dependence among these individuals. We utilized measures of risk factors in year 2002 to predict a diagnosis of opioid abuse or dependence in years 2003-2005. We analyzed four broad groups of possible risk factors: (i) non-opioid substance abuse disorders, (ii) physical health disorders, including painful physical health disorders, (iii) mental health disorders, and (iv) socio-demographic factors.

In adjusted models a diagnosis of non-opioid substance abuse was the strongest predictor of opioid abuse/dependence (OR=2.42, p<0.001). Mental health disorders were moderately strong predictors (OR=1.47, p=0.002) of opioid abuse/dependence. However, the prevalence of mental health disorders was much higher than the prevalence of non-opioid substance abuse disorders (45.6% vs. 7.9%). Males, younger adults, and patients with back pain were more likely to have opioid abuse/dependence.

Non-opioid substance abuse is the strongest risk factor for opioid abuse. While the odds ratio was smaller for mental health disorders than non-opioid substance abuse, the prevalence of mental health disorders was much higher than the prevalence of non-opioid substance abuse disorders in this population. Thus, the population-attributable risk (which is a function of the strength and prevalence of the risk factor) for opioid abuse/dependence from mental health disorders may actually be as great or greater than population-attributable risk from substance disorders in this population.

Clinicians need to carefully screen for substance abuse and mental health disorders in candidates for opioid therapy for CNCP and facilitate appropriate treatment of these disorders.