Pain and the Nonmedical Use of Prescription Opioids
Prescriptions for opioid analgesics are increasing. Simultaneously, there has been an increase in the prevalence of nonmedical use of these medications by patients and the public, leading to more patients with prescription opioid abuse and dependence. This population-based survey* collected demographic, psychiatric, and substance use data from 42,734 US adults to determine whether nonmedical use of prescription opioids is driven by untreated pain. Respondents were questioned about past-year nonmedical use of prescription opioids and the extent to which pain interfered with their activities of daily living (i.e., low, moderate, high). Primary findings were as follows:
- The past-year rate of nonmedical use of prescription opioids was 1.8%. Twenty percent of these individuals met criteria for opioid abuse/dependence.
- Pain was positively associated with an increased probability of nonmedical use and prescription opioid abuse/dependence.
- Within each level of pain, the odds of past-year nonmedical use and abuse /dependence were significantly higher for those with unhealthy alcohol use.
*The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).
Although limited by a cross-sectional design that prevents us from concluding a direct casual relationship, these results add to the evidence supporting the association between inadequately treated pain and the rise in nonmedical use of prescription opioids. Clinicians should screen for inappropriate use of prescription opioids in all patients with pain, monitor for evidence of abuse/dependence in those who are taking opioids, and be aware that unhealthy alcohol use increases the likelihood of nonmedical use.David A. Fiellin, MD
Novak SP, Herman-Stahl M, Flannery B, et al. Physical pain, common psychiatric and substance use disorders, and the non-medical use of prescription analgesics in the United States. Drug Alcohol Depend. 2009;100(1–2):63–70.