Characterization of Factors Associated with Long-Term Prescription Opioid Use in Support of Risk Mitigation Strategies in the Non-Cancer Population

• Published in: Drug safety 2022-10, Vol.45 (10), p.1302-1302
• Main Authors: Pujade, I, Castillon, G, Salvo, F, Moride, Y
• Format: Article
• Language: English
• Subjects: Back pain; Cancer; Confidence intervals; Estimates; Heterogeneity; Meta-analysis; Narcotics; Observational studies; Opioids; Pain; Patients; Quality assessment; Quality control; Risk analysis; Risk factors; Statistical analysis; Statistics; Subgroups; Substance use; Tobacco
• ISSN: 0114-5916; 1179-1942

Introduction: Long-term prescription opioid use in the non-cancer population is highly controversial as it is a known risk factor for opioid-related harms. The identification of modifiable and non-modifiable factors associated with long-term use may inform risk mitigation strategies when initiating or continuing treatment. Objective: In patients without cancer who initiate a prescription opioid, to estimate the incidence of progressing to long-term use and to identify associated factors. Methods: A systematic review and meta-analysis were conducted. Medline and Embase electronic databases were searched from 01 January 2009 to 15 January 2020. Additional sources were sought through pragmatic searches. Observational studies on long-term prescription opioid use in the non-cancer population of all ages, community-dwelling or institutionalized, and reporting a definition for long-term use of prescription opioids (LTPO), incidence estimates and/or associated factors were eligible. Two authors independently screened titles and abstracts, with conflicts resolved by a third author. Data were extracted by one author and validated by a second author. Methodological quality of individual studies was assessed using the Joanna Briggs Institute critical appraisal tools. For potential risk factors investigated in at least two studies, a meta-analysis of adjusted measures of association was conducted using a random effect model, and expressed as an odds ratio (OR) with corresponding 95% confidence interval (CI). Statistical heterogeneity of estimates was assessed using the I2 statistics. Results: A total of 64 observational studies including from 96 to 1,353,902 opioid users without cancer were included in the review. Among prescription opioid users, the incidence of progressing to long-term use ranged from 0.2 to 703.4 per 10,000 person-years (median: 41.6), with the highest incidence found in the post-surgical setting. Factors associated with long-term use were: obesity (OR 1.32; 95% CI 1.23-1.42), tobacco use (1.60; 1.42-1.80), anxiety (1.36; 1.14-1.61) and prescription for "any pain"' (1.64; 1.39-1.95), with no evidence of statistical heterogeneity across studies. In a subgroup analysis based on sociodemographic characteristics, LTPO definition and quality assessment, the following associated factors were also found: male sex, concomitant psychiatric disorder, pre-existing substance use disorder and back pain indication. Conclusion: This review demonstrated that long-t