Opioid Pain Treatment Raises Dependence and Use Disorder Rates

Nearly 1 in 10 patients with chronic pain treated with opioid analgesics experience dependence and opioid use disorder, a recent study found.^1,2

“Our study has strengthened the evidence base regarding the commonality of [pharmaceutical opioid use] in [chronic non-cancer pain] patients treated with opioids,” wrote investigators, led by Kyla Thomas, PhD, professor of Public Health Medicine at the University of Bristol.

The most common cause of disability worldwide is chronic non-cancer pain. Patients with chronic pain are often prescribed opioids despite this drug class’s evidenced harm and limited support of its long-term clinical benefit. Taking opioids is associated with accidental and fatal opioid overdose, problematic pharmaceutical opioid use, and transition to illicit drugs such as heroin or fentanyl.

Investigators sought to assess the prevalence of pharmaceutical opioid use in patients with chronic non-cancer pain treated with opioid analgesics. They conducted a comprehensive systematic literature review and meta-analysis leveraging data from MEDLINE, EMBASE, and PsycINFO databases from inception to January 27, 2021. The analysis included participants aged ≥ 12 with non-cancer pain of ≥ 3 months duration, treated with opioid analgesics. Case-control studies were excluded.

The study included 148 studies with > 4.3 million participants. However, 1% of studies were considered high risk of bias. Although investigators included studies from all settings, the research analyzed was predominantly from North America (n = 115) as well as high-income countries such as the United Kingdom (n = 5), France (n = 3), Spain (n = 4), Germany (n = 4), Australia (n = 2). The review included 7 studies from other countries.

Among the 148 studies, 106 were conducted between 2010 – 2021; the oldest study was from 1985. Sample sizes ranged from 15 – 2,304,181 patients.

The team divided pharmaceutical opioid use into 4 categories: dependence and opioid use disorder; signs and symptoms of dependence and opioid use disorder; aberrant behavior; and at risk of dependence and opioid use disorder. Investigators analyzed the data using a random-effects multi-level meta-analytical model.

A pooled analysis showed the prevalence of dependence and opioid use disorder was 9.3% (95% confidence interval [CI], 5.7 – 14.8%). Subgroup analyses showed ICD-9 and ICD-10 diagnostic tools had the lowest prevalence rates of 3% (95% CI, 1.7 – 5.3) and 2.4% (95% CI, 0.2 – 26.3), respectively. Greater prevalence rates were observed using DSM-III (9.9%; 95% CI, 4.6 – 19.8), DSM-4 (13.1%; 95% CI, 5.5 – 28.2), and DSM-5 (36.7%; 95% CI, 21.0 – 55.9).

The team also found significant differences in the prevalence of dependence and opioid use disorder when examining the study setting, study design, and 2 components of the risk of bias assessment response rate and appropriate data collection. The greatest prevalence rates were seen in pain clinics (29.2%; 95% CI, 13.1 – 53.0) and mixed settings (31.0%; 95% CI, 7.2 – 72.4) and the lowest observed in registry/database studies (1.9%; 95% CI, 1.0 – 3.5%).

Investigators found 29.6% of participants had signs and symptoms of dependence and opioid use disorder (95% CI, 22.1 – 38.3%) and 22% had aberrant behavior (95% CI, 17.4 – 27.3%). Moreover, 12.4% had a risk of dependence and opioid use disorder (95% CI, 4.3 – 30.7%).

Investigators wrote the prevalence, risk, and signs of dependence and opioid use disorder, as well as aberrant behavior, were affected by the study setting, study design, and diagnostic test. The study also revealed high heterogeneity, indicating the findings should be interpreted with caution.

Overall, not only did nearly 1 in 10 of patients treated with opioid analgesics experience dependence and opioid use disorder, but 1 in 3 presented signs and symptoms of dependence and opioid use disorder, 1 in 5 had aberrant behavior, and 1 in 8 patients were at risk of dependence and opioid use disorder.

“Clinicians and policy makers need a more accurate estimate of the prevalence of problematic opioid use in pain patients so that they can gauge the true extent of the problem, change prescribing guidance if necessary, and develop and implement effective interventions to manage the problem,” Thomas said in a press release. “Knowing the size of the problem is a necessary step to managing it.”

References

1. ^{Thomas, K, Dalili, M, Cheng, H, et al. Prevalence of problematic pharmaceutical opioid use in patients with chronic non-cancer pain: A systematic review and meta-analysis. 2024. DOI: 10.1111/add.16616}
2. ^{Prescription Painkiller Misuse and Addiction Are Widespread in Chronic Pain Patients. News Wise. August 5, 2024. https://www.newswise.com/articles/prescription-painkiller-misuse-and-addiction-are-widespread-in-chronic-pain-patients. Accessed August 7, 2024.}