Study suggests one in 10 chronic pain patients may become addicted to opioids

Results of the review and meta-analysis revealed that nearly 1 in 10 patients with chronic, non-cancer-related pain who take prescription opioid painkillers experience opioid dependence or opioid use disorder.

The review is Publication year Poisoning August 7, 2024reviewed data from 148 studies involving more than 4.3 million adults with chronic pain between 1985 and 2021, mainly from North America and other high-income countries, including the UK.

The authors included studies that reported problematic pharmaceutical opioid use (“POU”) and defined POU as four categories: addiction and opioid use disorder (“DOUD”) identified using diagnosis codes, signs and symptoms of DOUD, aberrant behaviors, and risk for DOUD.

The researchers found that the overall prevalence of DOUD was 9.3%, with 43 of 148 studies reporting DOUD identified using diagnosis codes (n=2,691,475).

Nearly one-third of patients (29.6%) were found to exhibit “signs and symptoms of DOUD”, reported in 44 studies (n=58,479).

Across 79 studies (n=1,180,289), more than one in five patients (22%) exhibited “abnormal behaviors” such as asking for early repeat prescriptions, repeatedly increasing doses, or frequently losing prescriptions, while eight studies (n=26,876) found that more than one in ten patients (12%) were at risk for DOUD, as they displayed characteristics that may increase their risk of developing DOUD in the future.

However, the authors point out: “These results should be interpreted with caution, given the high heterogeneity of the studies.”

“One study accounted for 54% of the total sample. Few studies were reported from low- or middle-income countries, and no data were available from Africa, South America, or the Caribbean,” the authors wrote.

The authors note that previous studies have found wide variation in the reported prevalence of problematic POUs.

“The main limitation is the inconsistent definition of POU due to the use of multiple definitions and terminology,” they said, citing “the small number of studies included in the review and the lack of robustness of data aggregation using different and inconsistent POU definitions.”

“However, despite the issues identified in the literature, there is enough evidence describing the scope of the problem for clinicians and policy makers to take appropriate action.

“Better approaches are urgently needed to prevent and manage POU in chronic non-cancer pain,” the paper adds.

Roger Knaggs, professor of pain management in the School of Pharmacy at the University of Nottingham and president of the British Pain Society, said: Pharmaceutical Journal“Only a small proportion of the included studies (five out of 148) were conducted in the UK, so these prevalence figures may not be directly applicable to our country.

“However, problematic use has been recognised by health professionals in all settings – community, primary and secondary care,” he said.

“A balanced approach is needed. Opioids are effective for acute pain, which is common after trauma or surgery, and for pain at the end of life. However, for many chronic non-cancer pain conditions, the evidence base is modest for short-term periods (up to three months) and even more limited for longer-term periods. Furthermore, there is growing awareness of a range of harms, including problematic use.

“Opioids should not be stopped abruptly or forced on individuals to taper. In most cases, reduction or deprescribing should be individualized with a person-centred approach, as emphasised in several national guidelines and policy initiatives. There is a growing body of evidence supporting effective and safe opioid tapering, including from two large NIHR-funded studies. iWatch and prompt.”

In May 2024, NHS Fife Pharmacist-led initiatives to reduce unnecessary prescribing Use of high-risk analgesics, including opioids, for chronic pain.

writing Pharmaceutical Journal July 2023, Pharmacist Rachel Berry Learn how North East and North Cumbria Integrated Care Board's #painkillersdontexist campaign was developed to highlight the risks of long-term painkillers.