Nearly 10% of those prescribed opioids become addicted

Key takeaways:

• Nearly one in three people showed signs and symptoms of opioid use disorder or opioid dependency.
• The findings show a need for novel strategies to prevent problematic opioid use.

Almost one in 10 patients treated with prescription opioid painkillers experience opioid dependency or opioid use disorder, a result from a systematic review and meta-analysis showed.

Nearly three in 10 patients in the analysis exhibited signs and symptoms indicating opioid dependency or opioid use disorder (OUD), according to researchers.

“Clinicians and policymakers need a more accurate estimate of the prevalence of problematic opioid use in pain patients so that they can gauge the true extent of the problem, change prescribing guidance if necessary, and develop and implement effective interventions to manage the problem,” Kyla H. Thomas, MBBS, MSc, MSc Res, MFPH, PhD, FFPH a professor of public health medicine at the University of Bristol in England, said in a press release. “Knowing the size of the problem is a necessary step to managing it.”

The findings conflict with claims from companies like Purdue Pharma, which have said that less than 1% of opioid prescriptions result in problems for patients, the release noted.

Prior studies that examined the prevalence of problematic opioid use in patients with chronic noncancer pain had various limitations, Thomas and colleagues wrote in their study, published in Addiction.

“A major limitation is the inconsistency in defining problematic opioid use with the use of multiple definitions and terminology (such as misuse, abuse, addiction, dependence, OUD, problematic use and aberrant behavior)” they explained.

The researchers aimed to overcome these caveats in a systematic review and meta-analysis of 148 studies — composed of over 4.3 million participants — taken from several databases.

The analysis used studies published up until January 2021. The studies came primarily from North America and high-income countries, with study sample sizes ranging from 15 to over 2 million participants.

Thomas and colleagues divided the studies into four categories based on how problematic opioid use was defined:

• opioid dependency and OUD, defined through diagnostic codes;
• signs and symptoms of opioid dependency and OUD, defined as symptoms like opioid cravings or withdrawal;
• aberrant behavior, defined as behaviors like seeking early refills and frequently lost prescriptions; and
• at risk for opioid dependency and OUD, defined as characteristics that could increase the risk for opioid dependency or OUD development.

Overall, the pooled prevalence was 9.3% (95% CI, 5.7%-14.8%) for opioid dependency and OUD, 29.6% (95% CI, 22.1%-38.3%) for signs and symptoms of opioid dependency and OUD, 22% (95% CI, 17.4%-27.3%) for aberrant behavior and 12.4% (95% CI, 4.3%-30.7%) for those at risk for dependency and OUD.

The researchers identified several study limitations, with the most significant being the “considerable” heterogeneity between the studies across outcomes, which they advised limits the reliability and general applicability of the findings. .

They concluded that the results show an urgent need for better approaches to problematic opioid use inpatients

Such strategies could include “the promotion of best practice in opioid prescribing, education of patients and prescribers regarding opioid-related harms [and] improving access to appropriate pain management,” they wrote.

References:

• Prescription painkiller misuse and addiction are widespread in chronic pain patients. https://www.eurekalert.org/news-releases/1052882. Published Aug. 7, 2024. Accessed Aug. 6, 2024.
• Thomas K, et al. Addiction. 2024;doi:10.1111/add.16616.