Age under 65 and History of a Psychiatric or Opioid Use Disorder Are Associated with a Current Prescription Opioid Use Disorder

Prescription opioid abuse is rising in the US, but the prevalence and risk factors among patients treated for chronic nonmalignant pain are uncertain. Researchers conducted telephone interviews diagnostic for an opioid use disorder (OUD) in a random sample of 702 patients from northeastern and central Pennsylvania who had received 4 or more opioid prescriptions for nonmalignant pain in the prior year.

• Thirty-six percent of patients met DSM-IV criteria for lifetime opioid dependence, and 26% met criteria for current dependence.

• Current dependence was associated with age <65 (odds ratio [OR], 1.85), high lifetime score on the Severity of Dependence Scale adapted for opioids (OR, 1.85), major depression (OR, 1.29), psychotropic medication use (OR, 1.73), and history of opioid abuse (OR, 3.81).

• The area-under-the-receiver-operating-characteristic curve of 0.77 meant that the model was 77% accurate in separating this sample of outpatient opioid users into groups with and without opioid dependence.

Comments:

This study suggests up to one-quarter of patients receiving opioids for chronic nonmalignant pain have a current OUD, but there are several problems with this conclusion. The assumption that patients with OUD are abusing their medication may be wrong, in that such patients may be more susceptible to pain syndromes. It is unfortunate the study does not report more detail about the nature of the chronic pain and misuse for pain management versus euphoria-seeking. In addition, the ability of the diagnostic interview and DSM-IV criteria to differentiate a true OUD (seeking drugs for euphoria) from pseudo-addiction (seeking drugs to relieve pain) is uncertain. Nonetheless, these results reinforce the importance of assessing substance-abuse and mental-health history in patients prescribed opioids for chronic nonmalignant pain.

Peter D. Friedmann, MD, MPH

Reference:

Boscarino JA, Rukstalis M, Hoffman SN, et al. Risk factors for drug dependence among outpatients on opioid therapy in a large US health-care system. Addiction. 2010;105(10):1776–1782.