Document Detail

Risk factors for clinically recognized opioid abuse and dependence among veterans using opioids for chronic non-cancer pain.
MedLine Citation:
PMID:  17449178     Owner:  NLM     Status:  MEDLINE    
A central question in prescribing opioids for chronic non-cancer pain (CNCP) is how to best balance the risk of opioid abuse and dependence with the benefits of pain relief. To achieve this balance, clinicians need an understanding of the risk factors for opioid abuse, an issue that is only partially understood. We conducted a secondary data analysis of regional VA longitudinal administrative data (years 2000-2005) for chronic users of opioids for CNCP (n=15,160) to investigate risk factors for the development of clinically recognized (i.e., diagnosed) opioid abuse or dependence among these individuals. We analyzed four broad groups of possible risk factors: (i) non-opioid substance abuse disorders, (ii) painful physical health disorders, (iii) mental health disorders, and (iv) socio-demographic factors. In adjusted models, a diagnosis of non-opioid substance abuse was the strongest predictor of opioid abuse/dependence (OR=2.34, p<0.001). Mental health disorders were moderately strong predictors (OR=1.46, p=0.005) of opioid abuse/dependence. However, the prevalence of mental health disorders was much higher than the prevalence of non-opioid substance abuse disorders (45.3% vs. 7.6%) among users of opioids for CNCP, suggesting that mental health disorders account for more of the population attributable risk for opioid abuse than does non-opioid substance abuse. Males, younger adults, and individuals with greater days supply of prescription opioids dispensed in 2002 were more likely to develop opioid abuse/dependence. Clinicians need to carefully screen for substance abuse and mental health disorders in candidates for opioid therapy and facilitate appropriate treatment of these disorders.
Mark J Edlund; Diane Steffick; Teresa Hudson; Katherine M Harris; Mark Sullivan
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2007-04-20
Journal Detail:
Title:  Pain     Volume:  129     ISSN:  1872-6623     ISO Abbreviation:  Pain     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-05-21     Completed Date:  2007-06-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7508686     Medline TA:  Pain     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  355-62     Citation Subset:  IM    
Central Arkansas Veterans Healthcare System, USA.
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MeSH Terms
Age Distribution
Aged, 80 and over
Analgesics, Opioid / therapeutic use*
Chronic Disease
Middle Aged
Neoplasms / epidemiology
Opioid-Related Disorders / epidemiology*
Pain / drug therapy*,  epidemiology*
Risk Assessment / methods*
Risk Factors
Sex Distribution
Socioeconomic Factors
United States / epidemiology
Veterans / statistics & numerical data*
Reg. No./Substance:
0/Analgesics, Opioid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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