Abstract
Treating pain and opioid use disorder represents a clinical challenge. While most studies that have assessed opioid analgesic use in opioid substitution treatment (OST) patients primarily address opioid analgesic misuse (1, 2), only few studies focused on OST patients assessed the prescription of analgesic opioids for chronic pain. We sought to compare the prevalence of analgesic opioid prescription (AOP) in two groups of chronic non-cancer pain (CNCP) patients: OST patients vs. the general population. This was a population-based cross-sectional study based on the French national healthcare claims database SNIIRAM (Système National d'Informations Inter-Régimes de l'Assurance Maladie) covering over 66 million people (98.8% of the French population). Overall, 67,173 participants ≥15 years old undergoing continuous OST in 2015 (“OST patients” group) were included and age- and gender-matched by means of a 1:1 ratio with 67,173 patients without OST (“control” group). In each group, patients with cancer conditions were excluded and those having received opioid and non-opioid analgesics for at least 3 months were identified (CNCP patients). Compared to control patients, CNCP OST patients received less AOP (47.8 vs. 68.0%, p < 0.0001) and more often non-opioid prescription (52.2 vs. 32.0%, p < 0.0001). In multivariate analysis, CNCP OST patients were 2.7 times less likely to be prescribed analgesic opioids (adjusted odds ratio [OR] = 2.7 [2.42–3.01], p < 0.0001) than control patients. AOP correlated in CNCP OST patients with: age ≤ 40 years old, female gender, low-income status, methadone-maintained treatment, mental health disorder, hepatitis C virus (HCV) infection, and alcohol abuse disorder. Opioid analgesics were less often prescribed in CNCP OST patients. AOP prevalence was 2.7-fold lower than in the general population. Chronic pain management in OST patients needs to be reinforced through additional physician training and a multidisciplinary approach.
Highlights
The use of analgesic opioids has dramatically increased over the last decade, in North America, Europe, and Oceania [3,4,5,6]
We identified 67,173 patients continuously treated with opioid substitution treatment (OST) (OST patients group) (67% HDB and 33% MTD) in 2015, ageand gender-matching them with 67,173 patients from the general population without OST or any diagnosed opioid abuse disorder (Figure 1)
The factors associated with analgesic opioid prescription (AOP) were female gender (OR: 1.17 [95% confidence intervals (95% CI): 1.07–1.27]), alcohol use disorder (OR: 1.44 [1.24–1.67]), mental health disorder (OR: 1.32 [1.20–1.44]), and OST (OR: 2.32 [2.09–2.57])
Summary
The use of analgesic opioids has dramatically increased over the last decade, in North America, Europe, and Oceania [3,4,5,6] This increased prescription of analgesic opioids is partly related to the promotion of opioid use in chronic non-cancer pain (CNCP) management, despite the remaining controversy due to high-level scientific evidence demonstrating their weak long-term benefit [6,7,8]. Focusing on patients receiving opioid substitution treatment (OST), studies have revealed higher prevalence of chronic pain, reported in 29–68% of methadone patients [16,17,18,19,20,21,22,23,24] and 40–49% of buprenorphine patients [19, 23, 25]. While most studies examining opioid analgesic use in OST patients have addressed opioid analgesic misuse [1, 2], only few have focused on OST patients who are prescribed analgesic opioids for chronic pain; the prevalence in this opioiddependent population of analgesic opioid prescription (AOP) ranged from 43 to 47% [17, 21, 27]
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