Researchers conducted a systematic review of literature exploring the misuse of opioid prescriptions for patients with chronic non-cancer pain.
For patients experiencing chronic non-cancer pain (CNCP), opioid prescription misuse is significantly prominent. Meanwhile, patients with CNCP have commonly experienced opioid dependence, addiction, or aberrant behavior as a result of their prescription misuse, leading researchers to highlight the urgent need for better CNCP treatment options.
CNCP is one of the most prominent causes of disability across the world and using opioids to treat it may be just as prominent. In this specific population, there is a lack of evidence regarding the long-term benefits of prescribing opioids, as well as the long-term harm that many patients with CNCP may be susceptible to if they proceed with opioid analgesic treatment options.1
“Long-term opioid prescribing has been associated with many harms, including accidental and fatal prescription opioid overdose, problematic pharmaceutical opioid use [POU], and transition to illicit use. In the US, overdose deaths caused by prescription opioid analgesics, illicit opioids such as heroin, and synthetic opioids such as fentanyl contribute to a ‘triple wave epidemic,’ which has been described as an opioid ‘crisis’ and declared as a public health emergency by the US Department of Health and Human Services,” wrote authors of a study published in Addiction, the journal of the Society for the Study of Addiction.1
The widespread nature of opioid prescribing in the US plays a key role in the ongoing opioid epidemic, which was responsible for more than 81,000 overdose deaths in 2023. Despite overdose deaths decreasing from 2022 to 2023—for the first time since 2018—widespread prescribing and new forms of opioids will continue to fuel the epidemic. One example of an opioid that has seen an increase in abuse is fentanyl, a synthetic type of opioid that is now the leading cause of opioid overdoses in the US.2
However, despite public health officials in recent years exhibiting a deeper focus on curbing the opioid epidemic in the US, researchers conducting this systematic review only analyzed literature leading up to January 2021. They explored decades of data dating back to the 1990s with the aim of understanding the overall prevalence of pharmaceutical opioid prescribing in CNCP patients using opioid analgesics.
The patient inclusion criteria for this meta-analysis were patients 12 or older prescribed opioid analgesics for the treatment of CNCP. The types of studies included ranged from cohort studies to longitudinal studies, cross-sectional studies (surveys), registry-based studies, incidence studies, retrospective chart reviews, and other variations.
“We included studies if they reported any POU, which was described in various ways in the literature, as follows: aberrant behavior abuse, addiction, substance dependence misuse, and substance use disorder,” wrote the authors.1 “We defined 4 categories of POU as follows: dependence and opioid use disorder (D&OUD) identified using diagnostic codes, signs and symptoms of D&OUD, aberrant behavior, and at risk of D&OUD. Four reviewers were involved in categorizing POU outcomes.” Researchers also categorized their results and conducted subgroup and sensitivity analyses to accompany the results.
While conducting their review, researchers came to the final decision of including a total of 148 studies. A total of 4,301,910 participants were included across all studies, whose settings ranged multiple continents.
Regarding the amalgamation of all studies included in this review, 43 reported D&OUD, 44 reported signs and symptoms of D&OUD, 79 reported aberrant behavior, and 8 studies assessed the prevalence of a patient being at-risk of D&OUD.
“The prevalence of POU is high with almost 1 in 10 people identified as D&OUD using diagnostic criteria or at risk of D&OUD, 1 in 3 showing [signs and symptoms] of D&OUD, and 1 in 5 showing aberrant behavior. However, there was considerable heterogeneity between studies across outcomes and variation in relation to classification and measurement of outcomes,” continued the authors.1
Along with patients experiencing cancer, individuals living with CNCP rely on opioid prescriptions to relieve their pain since therapeutic alternatives are few and far between. However, with the sheer prominence of opioid use leading to a major national epidemic, the potential of addiction development and opioid misuse makes the ongoing health crisis one of the most difficult in years’ past.
While opioid prescriptions will remain a viable option for patients with CNCP regardless of the potential in misuse, researchers urged clinicians to understand the true extent of patients’ symptoms and possibility of developing harmful habits following opioid prescribing.
“Clinicians and policymakers need a more accurate estimate of the prevalence of problematic opioid use in pain patients so that they can gauge the true extent of the problem, change prescribing guidance if necessary, and develop and implement effective interventions to manage the problem. Knowing the size of the problem is a necessary step to managing it,” concluded Kyla Thomas, lead author of the study, according to a University of Bristol news release.3
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