Risk factors for drug dependence among out‐patients on opioid therapy in a large US health‐care system

TLDR

The study assessed the prevalence and risk factors for opioid dependence among out‑patients on long‑term opioid therapy in a large US health‑care system. Using electronic health records, we identified out‑patients with ≥4 opioid prescriptions for non‑cancer pain and conducted diagnostic interviews with 705 patients to diagnose opioid use disorders and evaluate risk factors. Preliminary analyses found current opioid dependence in 26% of patients, with age < 65, prior opioid abuse, high dependence severity, major depression, and psychotropic medication use significantly associated with dependence; a combination of age, depression, psychotropic medication use, and pain impairment predicted dependence with OR 8.01, and a history of severe dependence and opioid abuse increased risk (OR 56.36).

Abstract

ABSTRACT Aims Our study sought to assess the prevalence of and risk factors for opioid drug dependence among out‐patients on long‐term opioid therapy in a large health‐care system. Methods Using electronic health records, we identified out‐patients receiving 4+ physician orders for opioid therapy in the past 12 months for non‐cancer pain within a large US health‐care system. We completed diagnostic interviews with 705 of these patients to identify opioid use disorders and assess risk factors. Results Preliminary analyses suggested that current opioid dependence might be as high as 26% [95% confidence interval (CI) = 22.0–29.9] among the patients studied. Logistic regressions indicated that current dependence was associated with variables often in the medical record, including age &lt;65 [odds ratio (OR) = 2.33, P = 0.001], opioid abuse history (OR = 3.81, P &lt; 0.001), high dependence severity (OR = 1.85, P = 0.001), major depression (OR = 1.29, P = 0.022) and psychotropic medication use (OR = 1.73, P = 0.006). Four variables combined (age, depression, psychotropic medications and pain impairment) predicted increased risk for current dependence, compared to those without these factors (OR = 8.01, P &lt; 0.001). Knowing that the patient also had a history of severe dependence and opioid abuse increased this risk substantially (OR = 56.36, P &lt; 0.001). Conclusion Opioid misuse and dependence among prescription opioid patients in the United States may be higher than expected. A small number of factors, many documented in the medical record, predicted opioid dependence among the out‐patients studied. These preliminary findings should be useful in future research efforts.