Does Prescribing Opioids for Chronic Noncancer Pain Contribute to Opioid Use Disorders?
Does opioid abuse or dependence result from the prescription of opioids for chronic noncancer pain? If so, are there discernable risk factors?
To answer these questions, researchers analyzed demographic and clinical data from 15,160 veterans with chronic opioid use (>90 day prescription) for noncancer pain but no opioid abuse or dependence diagnosis noted in their medical records in 2000–2002. Researchers then compared those veterans with a subsequent diagnosis of an opioid use disorder in 2003–2005 with veterans without this diagnosis in the same period.
- In 2002, 45% of veterans had a mental health diagnosis; 8% had a diagnosis of a nonopioid substance use disorder.
- Two percent of veterans were subsequently diagnosed with opioid abuse or dependence.
- In adjusted analyses, veterans with the following in 2002 were more likely to have a subsequent opioid abuse or dependence diagnosis in 2003–2005:
- nonopioid substance use disorder (OR, 2.3)
- mental health disorder (OR, 1.5)
- greater number of outpatient healthcare visits (OR, 1.5 for 20+ visits versus 0–6 visits)
- greater number of days supplied with opioids (OR, 1.8 for 211+ days versus 91–150 days)
This study clearly identified only those individuals whose unhealthy opioid use came to medical attention over 1–3 years. However, the modest proportion of patients who received regular opioids for chronic noncancer pain and later developed abuse or dependence suggests that opioid treatment generally may have a favorable benefit-risk ratio. Although the majority of those at risk for opioid problems may not subsequently develop them, knowledge of risk factors can alert clinicians to those who are more susceptible.Jeffrey H. Samet, MD, MA, MPH
Edlund MJ, Steffick D, Hudson T, et al. Risk factors for clinically recognized opioid abuse and dependence among veterans using opioids for chronic non-cancer pain. Pain. 2007;129(3):355–362.