Do Most Patients Prescribed Opioids Use Them as Directed?

A new study, recently published in the American Journal of Public Health, has found that the vast majority of adult patients who were prescribed opioids used them for medicinal purposes only. According to the work done by researchers at Columbia University Mailman School of Public Health, the New York State Psychiatric Institute and Vagelos College of Physicians and Surgeons, 31 percent of patients used their medication only as directed. Another four percent of patients reported they had misused their medication.

• Among patients who were misusers, close to 60 percent had either only misused their own prescription opioids (27 percent) or had misused prescribed opioids they had acquired without a prescription (31 percent) — as opposed to street drugs.
• The majority of without-a-prescription-only opioid misusers (88 percent) sourced their last batch of prescription drugs from within their close social circle (a relative or a friend).
• With very few exceptions, prescription-only misusers had received their last opioid prescription from one medical professional (98 percent), a statistic which seems to fly in the face of rumors of “doctor shopping” among those with an opioid abuse problem.

Identifying Prescription Opioid Users and Misusers Important

Denise Kandel, Ph.D., a professor of Sociomedical Sciences in Psychiatry at Columbia Mailman School of Public Health, stated that identifying the traits of prescription opioid misusers as opposed to patients who use their medications only as directed is “crucial for understanding who is most at risk for adverse outcomes” from this type of medication as well as focusing prevention efforts and treatment.

The researchers took data from the National Surveys on Drug Use and Health (2016-2017) to compare opioid prescription users with drug misusers, who were divided into three groups:

• Misusers who didn’t have a prescription
• Misusers of their own prescription
• Misusers who fell into both categories

The team also looked at whether patients used nicotine and alcohol and if they met the criteria for alcohol or marijuana abuse or dependence, as defined in DSM IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition).

Findings Isolated Most Frequently Misused Opioids

• The prescribed opioid medications misused most frequently were tramadol, hydrocodone and oxycodone.
• Fentanyl was prescribed as a pain reliever, especially among members of the prescription-only misuse group.
• Misusers of opioids without prescriptions tended to be younger than members of other groups.
• Misusers in both categories were more likely to use heroin.
• Patients who misused their medication were more likely to experience depression than those who used their medications only as directed.
• Misusers were also likely to have undergone alcohol abuse treatment and to have developed a dependency on marijuana. They were likely to consider their drug use as less risky behavior than patients who stick strictly to their doctor’s instructions regarding medications.

Based on the results, Dr. Kandel said that patients who are unable to find pain relief from their current treatment plan are more likely to misuse their opioid prescriptions. She said that patients must be able to access effective pain management services and from the perspective of public health, the results of the study suggest that several types of possible patient behavior should be considered from a harm reduction perspective. This would include those who misuse their medications too.