Risk factors for opioid misuse


  • International Clinical Digest
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Takeaway

  • In this meta-analysis, younger people, men, people with mental-health diagnoses, and those with any substance use were likelier to commence opioid misuse after being prescribed opioids for pain.

Why this matters

  • Targeting higher-risk patients for alternative pain treatments might curb misuse.
  • Not enough is known about risk factors for opioid misuse, including among the opioid-naive.

Key results

  • Among 16 dichotomous risk factors were:
    • Male sex: OR, 1.23 (95% CI, 1.10-1.36);
    • Age
    • Any substance use: OR, 3.55 (95% CI, 2.62-4.82); and
    • Any mental-health diagnosis: OR, 2.45 (95% CI, 1.91-3.15).
  • Among 6 continuous risk factors were younger age, increased pain, longer opioid exposure duration, higher doses.
  • In opioid-naive subgroup, risk factors were the same, but tended to be stronger.  
  • Protective factors: being employed, having arthritis. 

Study design

  • Systematic review of 65 studies patients who were prescribed the drugs for non-cancer-related pain; 43 were meta-analyzed (n=30,571,969-30,586,274).
  • They assessed risk factors for opioid misuse in this population.
  • Outcome: opioid misuse.
  • Funding: Canadian Institutes of Health Research.

Limitations

  • High heterogeneity.
  • Many studies had high bias risk.
  • Interactions between risk factors not assessed.
  • Few studies assessed provider-, system-level risk factors.