Risk factors for indicators of opioid-related harms amongst people living with chronic non-cancer pain: findings from a 5-year prospective cohort study
Campbell, G and Noghrehchi, F and Nielsen, S and Clare, P and Bruno, R and Lintzeris, N and Cohen, M and Blyth, F and Hall, W and Larance, B and Hungerford, P and Dobbins, T and Farrell, M and Degenhardt, L, Risk factors for indicators of opioid-related harms amongst people living with chronic non-cancer pain: findings from a 5-year prospective cohort study, EClinicalMedicine, 28 Article 100592. ISSN 2589-5370 (2020) [Refereed Article]
Background: The literature suggests patient characteristics and higher opioid doses and long-term duration
are associated with problematic opioid behaviours but no one study has examined the role of all these factors
simultaneously in a long-term prospective cohort study.
Methods: Five-year, community-based, prospective cohort of people prescribed opioids for chronic non-cancer
pain (CNCP). Logistic mixed effect models with multiple imputation were used to address missing data.
Oral morphine equivalent (OME) mg per day was categorised as: 0 mg OME/day, 149 mg OME/day (reference),
5089 mg OME/day, 90199 mg OME/day and 200mg+ OME/day. Patient risk factors included: age,
gender, substance use, mental health history and pain-related factors. Main outcomes included: Prescribed
Opioids Difficulties Scale (PODS), Opioid-Related Behaviours In Treatment (ORBIT) scale, and ICD-10 opioid
dependence. Multiple confounders for problematic opioid behaviours were assessed.
Findings: Of 1,514 participants 44.4% weremale (95%CI 41.946.9) and theirmean agewas 58 years (IQR 4867).
Participants had a mean duration of pain of 10 years (IQR 4.520.0) and had been taking strong opioids for a
median of four years (IQR 1.010.0). At baseline, median OME/day was 73 (IQR 35148). At 5-years, 85% were
still taking strong opioids. PODS moderate-high scores reduced from 59.9% (95%CI 58.861.0) at baseline to
51.5% (95%CI 50.053.0) at 5-years. Around 9% met criteria for ICD-10 opioid dependence at each wave. In
adjusted mixed effect models, the risk factors most consistently associated with problematic opioid use were:
younger age, substance dependence, mental health histories and higher opioid doses.
Interpretation: Both patient risk factors and opioid dose are associatedwith problematic opioid use behaviours.
opioid dependence, pharmaceutical opioid, chronic non-cancer pain, cohort, dependence, extra medical use