Aberrant medication-related behaviors do not differ based on opioid dose: Results from a comprehensive medical record review

Cavanagh R, Gritzner S, Dobscha SK, Morasco BJ. Aberrant medication-related behaviors do not differ based on opioid dose: Results from a comprehensive medical record review. Presented at: International Association for the Study of Pain Annual Meeting; 2014 Oct 7; Buenos Aires, Brazil.

Aim of Investigation: As opioid medication doses increase, the severity and frequency of side effects, such as respiratory depression, overdose, and death, increase as well. While it is known that patients may misuse prescription opioids, there is little research examining whether rates of misuse may vary based on opioid dose. This study aims to determine if patients prescribed opioids for chronic non-cancer pain (CNCP) engage in medication misuse behaviors at different rates based on opioid dosage. Methods: Retrospective chart review from 2008-2010 compared patients with CNCP by opiate dose. The study utilized medical records from patients who received treatment at a VA medical center in the Pacific Northwest. Patients with CNCP who were prescribed opioid medications for 90 consecutive days or longer were classified as long-term opioid use. Patients were divided into two groups based on prescription opioid doses: (1) those prescribed high doses of opioid medications ( > 180 mg morphine equivalent per day) (n = 60) and (2) those prescribed traditional doses of opioid medications (5-179 mg morphine equivalent per day) (n = 60). Medication misuse behaviors, such as obtaining opioid prescriptions from multiple providers, not using medication as prescribed, reporting medication lost or stolen, or positive urine drug tests, were recorded when documented in the patients' medical chart. Results: Over a 2-year time period, 64.2% of the patients on any dose of long-term opioids had at least one potential aberrant medication-related behavior documented in their medical records; the rate did not significantly differ based on opioid dose, as 70% of the high-dose group and 58.3% of the traditional-dose group had at least one potential aberrant medication-related behavior documented in their medical records (p = 0.183). The high-dose group had higher rates of requesting an early refill or a dose escalation than the traditional-dose group (53.3% versus 35.0 %, p = 0.043). Forty-five percent of the high-dose group (n = 27) and 20% of the traditional dose group (n = 12) were administered a urine drug test (UDT) in the study period. Of patients administered a UDT, those in the high-dose group (n = 13) were less likely to have an aberrant result than patients in the traditional-dose group (n = 10) (48.1% versus 83.3%, p = 0.039). No other significant differences were found in the frequency of documented aberrant medication-related behaviors. Conclusions: In this retrospective chart review study of patients prescribed chronic opioid therapy for CNCP, the overall rate of prescription opioid misuse behaviors documented over a two-year period in the medical record was 64.2%. There were few differences in rates of documented prescription opioid misuse behaviors based on opioid dose. These findings should be considered by providers when creating opioid treatment agreements to accommodate that aberrant behaviors commonly occur with this population. Future research should explore the biopsychosocial factors that may contribute to these behaviors.