(432) Predictors of prescription opioid therapy in patients with chronic pain and a history of substance use disorder

Abstract

Patients with a history of substance use disorder (SUD) are frequently prescribed opioid medications for chronic pain, yet it is not clear what factors affect prescribing practices for this population. This study examined correlates of receipt of prescription opioid therapy in 214 patients with a SUD history receiving care at one Veterans Health Administration (VHA) medical center. Participants had one or more recent chronic non-cancer pain diagnoses documented in their VHA electronic medical records. Participants completed psychosocial questionnaires assessing pain impact, emotional distress, pain self-efficacy, pain catastrophizing, and pain severity. In addition, historical medical diagnoses and opioid pharmacy data were abstracted from their VHA electronic medical records. Participants were divided into three groups based on opioid prescriptions in the past 90 days: (1) no opioid therapy (n=134), (2) short-term opioid therapy (<90 days; n=31), or (3) chronic opioid therapy (90 days; n=49). Relative to participants with no or short-term opioid therapy, participants prescribed chronic opioid therapy had a greater number of pain diagnoses (p<0.01); higher levels of pain severity (p<0.01), interference (p<0.01), and catastrophizing (p<0.01); and lower chronic pain self-efficacy (p<0.01). Depression, post-traumatic stress disorder, and active SUD were unrelated to opioid therapy in bivariate analyses. In a multivariate logistic regression model, only self-reported pain interference remained a significant predictor of any opioid therapy (p<0.05, OR=1.38), after controlling for demographic and clinical characteristics. Findings highlight the occurrence of poor pain-related functioning in patients with SUD histories who are prescribed opioid therapy. Prescribing clinicians may consider adjuvant analgesic therapies and psychosocial interventions for these patients to further improve pain-related functioning and quality of life. This study was funded in part by grants from the National Institute on Drug Abuse (to B.J.M.) and VA Health Services Research & Development (to T.I.L.).