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Risk factors for indicators of opioid-related harms amongst people living with chronic non-cancer pain: findings from a 5-year prospective cohort study

Citation

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]


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Copyright 2020 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license

DOI: doi:10.1016/j.eclinm.2020.100592

Abstract

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.

Item Details

Item Type:Refereed Article
Keywords:opioid dependence, pharmaceutical opioid, chronic non-cancer pain, cohort, dependence, extra medical use
Research Division:Psychology
Research Group:Clinical and health psychology
Research Field:Health psychology
Objective Division:Health
Objective Group:Public health (excl. specific population health)
Objective Field:Substance abuse
UTAS Author:Bruno, R (Associate Professor Raimondo Bruno)
ID Code:142452
Year Published:2020
Funding Support:National Health and Medical Research Council (APP1022522)
Deposited By:Psychology
Deposited On:2021-01-18
Last Modified:2021-02-10
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