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22-12-2013 | Pain medicine | Article

Opioid users characterized by complex health needs


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medwireNews: People prescribed opioid analgesics tend to have complex physical and psychologic needs, Australian researchers report.

Their findings lend support to the “adverse selection” phenomenon of opioid prescribing and indicate that the boundaries for such selection are wide, even in a population setting where access to healthcare is relatively equitable.

Kris Rogers (University of Sydney, New South Wales) and colleagues investigated opioid analgesic use in the Australian community. They obtained baseline information on 99,698 participants in the “45 and Up Study,” a population-based cohort study of people aged 45 years and over, and linked this with prescription medicine data for the subsequent 12 months.

In all, 19.8% of the cohort had one or more opioid analgesics dispensed during the study period. Around half (51.6%) received acute treatment (mean 1.45 dispensings over 44.5 days), 26.3% received episodic treatment (mean 7.4 dispensings over 240 days), and 21.8% received long-term treatment (mean 14.9 dispensings over 329 days).

Codeine was the most commonly dispensed opioid analgesic in all three groups, accounting for 68.5%, 67.6%, and 56.6% of all prescriptions, respectively. The mean dose of codeine was highest in the acute group, at 5.1 mg/day morphine equivalent dose (MED) and lowest in the episodic group, at 1.8 mg/day MED.

Morphine was generally confined to the long-term treatment group, 10.4% of whom were dispensed the drug, compared with just 1.4% and 3.9% of the acute and episodic groups, respectively. Buprenorphine was also most frequently used as long-term treatment, at 15.9%, compared with 3.2% and 9.7% in acute and episodic treatment, respectively.

Hydromorphine and methadone were rarely used, but methadone users were notable for the high doses they were dispensed (mean 341 mg/day MED).

In terms of clinical and demographic factors, women slightly outnumbered men in all three opioid treatment categories and participants aged 65 to 69 years had the highest prevalence of opioid use by age.

Compared with people who were not prescribed opioids, opioid users had greater health-related needs, with lower self-rated health and self-rated quality of life, a higher number of chronic conditions, and worse physical function. Opioid users were also more likely than nonusers to report recent joint replacement surgery, acetaminophen use, and recent treatment for anxiety, depression, and osteoarthritis.

Writing in PLOS One, the authors say their findings “suggest that longer-term opioid analgesic dispensing is being seen in groups who could be seen at higher risk of poor health based on a wide range of health and non-health factors characterised by poor physical and psychological health, and social disadvantage.”

They add: “These [factors] need to be fully captured and accounted for in evaluating the role of opioid analgesic therapy within populations.”

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Joanna Lyford, Senior medwireNews Reporter