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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

Journal Article


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Abstract


  • © 2020 The Authors 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, 1–49 mg OME/day (reference), 50–89 mg OME/day, 90–199 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% were male (95%CI 41.9–46.9) and their mean age was 58 years (IQR 48–67). Participants had a mean duration of pain of 10 years (IQR 4.5–20.0) and had been taking strong opioids for a median of four years (IQR 1.0–10.0). At baseline, median OME/day was 73 (IQR 35–148). At 5-years, 85% were still taking strong opioids. PODS moderate-high scores reduced from 59.9% (95%CI 58.8–61.0) at baseline to 51.5% (95%CI 50.0–53.0) 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 associated with problematic opioid use behaviours.

Authors


  •   Campbell, Gabrielle (external author)
  •   Noghrehchi, Firouzeh (external author)
  •   Nielsen, Suzanne (external author)
  •   Clare, Phillip (external author)
  •   Bruno, Raimondo (external author)
  •   Lintzeris, Nicholas (external author)
  •   Cohen, Milton (external author)
  •   Blyth, Fiona (external author)
  •   Hall, Wayne (external author)
  •   Larance, Briony
  •   Hungerford, Phillip (external author)
  •   Dobbins, Timothy (external author)
  •   Farrell, Michael (external author)
  •   Degenhardt, Louisa (external author)

Publication Date


  • 2020

Citation


  • Campbell, G., Noghrehchi, F., Nielsen, S., Clare, P., Bruno, R., Lintzeris, N., Cohen, M., Blyth, F., Hall, W., Larance, B., Hungerford, P., Dobbins, T., Farrell, M. & Degenhardt, L. (2020). 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,

Scopus Eid


  • 2-s2.0-85092906655

Ro Full-text Url


  • https://ro.uow.edu.au/cgi/viewcontent.cgi?article=1368&context=asshpapers

Ro Metadata Url


  • http://ro.uow.edu.au/asshpapers/342

Place Of Publication


  • United Kingdom

Abstract


  • © 2020 The Authors 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, 1–49 mg OME/day (reference), 50–89 mg OME/day, 90–199 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% were male (95%CI 41.9–46.9) and their mean age was 58 years (IQR 48–67). Participants had a mean duration of pain of 10 years (IQR 4.5–20.0) and had been taking strong opioids for a median of four years (IQR 1.0–10.0). At baseline, median OME/day was 73 (IQR 35–148). At 5-years, 85% were still taking strong opioids. PODS moderate-high scores reduced from 59.9% (95%CI 58.8–61.0) at baseline to 51.5% (95%CI 50.0–53.0) 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 associated with problematic opioid use behaviours.

Authors


  •   Campbell, Gabrielle (external author)
  •   Noghrehchi, Firouzeh (external author)
  •   Nielsen, Suzanne (external author)
  •   Clare, Phillip (external author)
  •   Bruno, Raimondo (external author)
  •   Lintzeris, Nicholas (external author)
  •   Cohen, Milton (external author)
  •   Blyth, Fiona (external author)
  •   Hall, Wayne (external author)
  •   Larance, Briony
  •   Hungerford, Phillip (external author)
  •   Dobbins, Timothy (external author)
  •   Farrell, Michael (external author)
  •   Degenhardt, Louisa (external author)

Publication Date


  • 2020

Citation


  • Campbell, G., Noghrehchi, F., Nielsen, S., Clare, P., Bruno, R., Lintzeris, N., Cohen, M., Blyth, F., Hall, W., Larance, B., Hungerford, P., Dobbins, T., Farrell, M. & Degenhardt, L. (2020). 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,

Scopus Eid


  • 2-s2.0-85092906655

Ro Full-text Url


  • https://ro.uow.edu.au/cgi/viewcontent.cgi?article=1368&context=asshpapers

Ro Metadata Url


  • http://ro.uow.edu.au/asshpapers/342

Place Of Publication


  • United Kingdom