Pain Patients at Risk for Opiate Addiction

Summary
Opioid drugs are prescribed for chronic pain but also have a misuse potential. This study examined risk reduction strategies adopted by primary care physicians in preventing such abuse. The study found that there is a low use of risk reduction strategies by physicians. For example, urine drug testing is carried out in only 8 percent of patients. Strict control over early refills of prescriptions and insistence on regular office visits are two other conditions that may be adopted for monitoring patients on these drugs.

Introduction
Opioids are a class of drugs related to opium and are commonly used to relieve chronic pain. Patients can easily misuse the opioid prescriptions to aid an addiction. Researchers have noted that a number of opioid prescriptions for chronic non-cancerous pain are on the rise. This has resulted in an increase in opioid abuse, addiction and death related to opioid overdoses. Urine drug testing, mandatory office visits and predetermined prescription refill schedule for these drugs are a few of the strategies suggested for controlling misuse. Patients with a history of drug abuse, alcohol and tobacco addiction are more likely to misuse opioid prescriptions. Most of the chronic pain patients receive prescriptions as part of primary health care. This study was aimed at finding how strongly the primary care physicians followed risk reduction strategies to prevent opioid misuse.

Methodology
* A total of 1,612 patients from eight primary care practices within the University of Pennsylvania Health System receiving opioid drugs for chronic pain were included in this study.
* Electronic medical records were searched for risk factors for opioid misuse. These included people who were less than 45 years old, with drug or alcohol use disorder, tobacco use and mental health disorders.
* The records were searched for three risk reduction strategies: any urine drug test, regular office visits and restricted early refills.
* Association between risk factors for opioid misuse by patients and risk reduction strategies employed by physicians was studied.

Results
* Of the 1,612 patients, 8 percent had urine drug testing, 49.8 percent visited the office regularly, and 76.6 percent received restricted early refills.
* Of 1,612 patients, 469 were below the age of 45 years, 123 had drug use disorders, 73 had alcohol use disorders and 780 had mental health disorders.
* People with drug use disorders were likely to undergo the urine drug tests four times more than the patients associated with other risk factors for opioid misuse.
* Mean number of opioid prescriptions per month received by patients with a drug use disorder was 27.5 while this value was 19.6 for non-drug disorder patients. Average number of office visits was not associated with any risk factors.

Next steps/Shortcomings
This study used data from a single university health care system and the findings may not be applicable universally. Most of the patients were African-American females from low-income groups. The data used was from electronic records and not obtained by actual patient interviews, so some information might be missing. The severity of risk factors in each patient was not considered. The research fails to indicate the time frame in which the physicians became aware of opioid misuse and adopted risk reduction strategies.

Conclusion
This study found that fewer than 10 percent of patients receiving opioid prescriptions for chronic pain were monitored by urine drug tests by primary physicians. About 23 percent of such patients received early refills of the prescriptions. Patients having drug use disorders were likely to receive more number of prescriptions and early refills. They did have urine drug testing; but it was not frequent and about one-quarter of the patients with three or more risk factors had less then one urine drug test. All these facts point out that primary care physicians have still not adopted risk reduction strategies aimed at preventing the misuse of opioid drugs. This research demonstrates the need for a standardized approach to identify and monitor patients with higher risk of misuse. Primary care physicians need to be made aware of this as opioid misuse has larger public health implications.

For More Information:
Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain
Joanna L. Starrels, MD, MS; William C. Becker, MD; Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York and Yale University School of Medicine, New Haven, Connecticut

*FYI Living Lab Reports Are Summaries of the Original Research.

 


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