Abstract
ABSTRACT Background Despite the epidemic of nonmedical analgesic use (NMAU) in North America, there is a scarcity of research quantifying the effect of pain on NMAU. Aims This study sought to investigate the relationship between NMAU and functional pain interference, defined as the perceived level of interference in performing activities of daily living due to pain, in a population-based sample of the general Canadian population. Methods Data from the 2012 Canadian Community Health Survey (CCHS)–Mental Health, a nationally representative cross-sectional survey, were used to conduct bivariable and multivariable logistic regression analyses. Results The weighted prevalences of pain and NMAU were 20.6% and 6.6%, respectively. After adjusting for age, sex, education, culture/race, and chronic mental health diagnosis, a dose–response relationship was observed between higher functional pain interference and increased odds of NMAU, ranging from 1.61 (95% confidence interval [CI], 1.22–2.12) to 2.98 (95% CI, 2.21–4.01) from the lowest to the highest levels of functional pain interference. Elevated odds of NMAU were also observed among younger respondents aged 20–29 years and 15–19 years, respondents with a chronic mental illness diagnosis, and males. Secondary analyses revealed that the dose–response relationship between greater function pain interference and increased odds of NMAU persisted within subgroups with and without mental illness, as well as within subgroups aged 40 to 69. Conclusions These findings highlight the potential role of pain on increasing NMAU and the need for targeted strategies to reduce harms of NMAU among high-risk subgroups such as young adults.
Highlights
IntroductionAnalgesic misuse or nonmedical analgesic use (NMAU) generally refers to the use of analgesics in any way other than directed by a prescription (e.g., alternate route, dose or frequency, or use of analgesics obtained from acquaintances or streetbased drug markets).[18] Previous studies have found significant positive correlations between pain and NMAU,[19,20] as well as a high prevalence of co-occurring pain and NMAU.[21,22] The frequency of concurrent pain and NMAU may be in part due to practitioners denying prescriptions for analgesia as a result of concerns regarding dependence, misuse, or diversion.[23,24] individuals may feel stigmatized and subsequently avoid seeking health care, opting instead to self-manage pain using diverted analgesics.[25,26] Alternatively, individuals may transition to NMAU secondary to developing tolerance or addiction to prescribed analgesics and potentially even transition to heroin or other illicit opioid use.[27,28,29,30]
Worldwide, pain is one of the most common reasons for seeking medical care, representing approximately 20% to 50% of primary care visits[1,2] and up to 78% of hospital emergency department visits.[3]
Increasing proportions of nonmedical analgesic use (NMAU) were observed within each increasing level of functional pain interference (e.g., NMAU was reported by 5.4% of respondents with no pain, compared to 14.5% of respondents with the highest level of functional pain interference)
Summary
Analgesic misuse or nonmedical analgesic use (NMAU) generally refers to the use of analgesics in any way other than directed by a prescription (e.g., alternate route, dose or frequency, or use of analgesics obtained from acquaintances or streetbased drug markets).[18] Previous studies have found significant positive correlations between pain and NMAU,[19,20] as well as a high prevalence of co-occurring pain and NMAU.[21,22] The frequency of concurrent pain and NMAU may be in part due to practitioners denying prescriptions for analgesia as a result of concerns regarding dependence, misuse, or diversion.[23,24] individuals may feel stigmatized and subsequently avoid seeking health care, opting instead to self-manage pain using diverted analgesics.[25,26] Alternatively, individuals may transition to NMAU secondary to developing tolerance or addiction to prescribed analgesics and potentially even transition to heroin or other illicit opioid use.[27,28,29,30]. Conclusions: These findings highlight the potential role of pain on increasing NMAU and the need for targeted strategies to reduce harms of NMAU among high-risk subgroups such as young adults
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