Problematic opioid behaviours associated with pre-existing risk factors rather than opioid dosage alone, says new report

Problematic opioid behaviours in people with chronic pain, including opioid dependence, are associated with patient risk factors like younger age, substance dependence and mental health histories rather than simply higher opioid doses says a new report.

In one of the largest and most detailed studies to date, researchers from the National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, have analysed findings from a five-year cohort of 1,514 people who have been prescribed opioids for chronic non-cancer pain.

Lead author, Dr Gabrielle Campbell, Senior Research Fellow at the University of the Sunshine Coast and adjunct at NDARC said: “This report suggests that risk for problematic opioid outcomes is related to a combination of patient characteristics and pre-existing factors rather than opioid dose alone.”

The report found that at cohort entry, participants had been prescribed an opioid for a median of four years. At the five-year follow up, 85 per cent remained on opioid medication, with over half (56 per cent) taking more than 50mg OME/per day. Approximately nine per cent of the cohort met criteria for opioid dependence.

“Long-term opioid use for people living with chronic non-cancer pain is common. This has traditionally been associated with concerns of increased rates of adverse harms related to opioid use, particularly dependence and overdose,” said Dr Campbell.

The report comes in response to concerns that patients with chronic non-cancer pain have been exposed to abrupt and forced tapering and cessation of opioids simply for being on a high dose and concern that a higher dose is associated with problematic opioid behaviours.

“It is possible that this emphasis on dose comes from the ability to easily measure and respond to dose thresholds, compared with the relative complexity and time considerations of assessing other clinical factors that substantially contribute to opioid-related risk,” said Dr Campbell.

“There is a need for more nuanced assessment of risks and benefits experienced by patients, and an avoidance of overreliance on opioid dose as a predictor of these problems.”