Doctor shopping among chronic noncancer pain patients treated with opioids in the province of Quebec (Canada): incidence, risk factors, and association with the occurrence of opioid overdoses

Objective: Identify opioid abuse risk factors among chronic noncancer pain (CNCP) patients receiving long-term opioid therapy and assess healthcare resource use (HRU) among patients at elevated abuse risk.Design: Data were obtained from an integrated administrative claims database. Classification and Regression Tree (CART) analysis identified risk factors potentially predictive of opioid abuse, which were used to classify the overall population into cohorts defined by levels of abuse risk. Multivariable logistic regression compared HRU across risk cohorts.Setting: Retrospective cohort study.Patients, participants: 21,072 patients aged ≥18 years diagnosed with ≥1 of 5 types of CNCP and a prescription for Schedule II or III/IV opioid medication used long-term (≥90 days).Main outcome measures: (1) Opioid abuse risk factors; (2) HRU differences between risk cohorts.Results: CART analysis identified four groups at elevated opioid abuse risk defined by three factors (age, daily opioid dose, and total days’ supply of opioids); sensitivity: 70.3 percent, specificity: 74.1 percent, and positive predictive value: 5.6 percent. The analysis results were used to classify patients into low-risk (72.5 percent), at-risk (25.4 percent), and opioid-abuser (2.2 percent) cohorts. In multivariable analysis, emergency department (ED) use was higher among at-risk vs low-risk patients (odds ratio [OR]: 1.14; p < 0.05); hospitalization and ED visits were higher for opioid-abusers vs low-risk patients (OR: 2.33 and 2.14, respectively; p < 0.05).Conclusions: This study identifies a subpopulation of CNCP patients at risk of opioid abuse. However, limited sensitivity and specificity of criteria defining this subpopulation reinforce the importance of physician discretion in patient-level treatment decisions.

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Tramadol Use and Dependence in Chronic Noncancer Pain Patients

Pharmacopsychiatry ◽

10.1055/s-2004-827177 ◽

2004 ◽

Vol 37 (4) ◽

pp. 191-192 ◽

Cited By ~ 13

Author(s):

M. Soyka ◽

M. Backmund ◽

S. Hasemann

Keyword(s):

Chronic Noncancer Pain ◽

Noncancer Pain ◽

Pain Patients

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What Factors Affect Physicians' Decisions to Prescribe Opioids for Chronic Noncancer Pain Patients?

Clinical Journal of Pain ◽

10.1097/00002508-199712000-00011 ◽

1997 ◽

Vol 13 (4) ◽

pp. 330-336 ◽

Cited By ~ 100

Author(s):

Dennis C. Turk ◽

Akiko Okifuji

Keyword(s):

Chronic Noncancer Pain ◽

Noncancer Pain ◽

Pain Patients

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Prescribing opioids for chronic noncancer pain: predicting response and assessing risk factors

Pain Management ◽

10.2217/pmt.13.34 ◽

2013 ◽

Vol 3 (5) ◽

pp. 325-328 ◽

Cited By ~ 3

Author(s):

Geana Paula Kurita ◽

Per Sjøgren

Keyword(s):

Risk Factors ◽

Chronic Noncancer Pain ◽

Noncancer Pain

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The Role of Simulated-Experience and Descriptive Formats on Perceiving Risks of Strong Opioids: A Randomized Controlled Trial With Chronic Noncancer Pain Patients

Patient Education and Counseling ◽

10.1016/j.pec.2021.10.002 ◽

2021 ◽

Author(s):

Odette Wegwarth ◽

Wolf Dieter Ludwig ◽

Claudia Spies ◽

Erika Schulte ◽

Ralph Hertwig

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Chronic Noncancer Pain ◽

Randomized Controlled ◽

Noncancer Pain ◽

Strong Opioids ◽

Pain Patients

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Breakthrough pain in opioid-treated patients with neuropathic pain

Journal of Opioid Management ◽

10.5055/jom.2006.0051 ◽

2006 ◽

Vol 2 (6) ◽

pp. 347 ◽

Cited By ~ 4

Author(s):

Steve Simon, MD, RPh ◽

Daniel S. Bennett, MD ◽

Richard Rauck, MD ◽

Donald Taylor, MD ◽

Steven Shoemaker, MD

Keyword(s):

Neuropathic Pain ◽

Breakthrough Pain ◽

Median Number ◽

Rapid Onset ◽

Maximum Intensity ◽

Chronic Neuropathic Pain ◽

Chronic Noncancer Pain ◽

Study Population ◽

Noncancer Pain ◽

Pain Patients

Objective: This report aims to describe the prevalence and characteristics of breakthrough pain in patients with neuropathic pain.Methods: The study represents data from a subset of patients from a larger survey of 228 patients with chronic noncancer pain. Patients were identified from nine pain programs and were administered a telephone questionnaire. The study population comprised 45 chronic noncancer pain patients with primary neuropathic pain diagnoses who were being treated with opioids.Results: Pain had been present for a median of six years. Medications used for pain in addition to opioids included nonsteroidal anti-inflammatory agents (29 percent), antidepressants (60 percent), and anticonvulsants (53 percent). Thirty-five of the patients (78 percent) described a total of 42 distinct types of breakthrough pain. The median number of episodes per day was two; the median time to maximum intensity was 10 minutes, and the median duration of pain was 60 minutes. Patients could identify a precipitant for 62 percent of the pains, and 88 percent of the precipitants were activity related. The onset of breakthrough pain could not be predicted for 48 percent of the pains and could only sometimes be predicted for 29 percent of the pains.Conclusion: Breakthrough pain is common in opioidtreated patients with chronic neuropathic pain. Such pain often has a rapid onset and a relatively short duration, and it is frequently difficult to predict, similar to breakthrough pain in cancer patients.

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