Nonmedical opioid use for reasons other than pain relief is common among middle-aged adults in residential addictions treatment.
Moreover, this type of opioid use was associated with more extensive use of other controlled substances and select street drugs, and poorer mental health, than was opioid use motivated by pain relief alone, a study shows (Addict. Behav. 2013;38:1776-81).
"Collectively, these data provide further evidence that individuals who use opioids nonmedically for reasons other than pain relief constitute a group that is particularly high risk for poor health outcomes," asserted Amy S. B. Bohnert, Ph.D., of the department of psychiatry, University of Michigan, Ann Arbor.
Two prior studies showed that nonmedical opioid use for reasons other than pain relief is more common than is opioid use for pain relief only, but the studies were among adolescents and relatively high functioning young adults, such as college students.
The current study involved older adults with more established patterns of substance abuse, reaching an average of 10.8 years of regular alcohol use to intoxication, 8.1 years for cocaine, and 6.2 years for heroin.
The average age of the cohort was 35.6 years, placing them into an age group (35-54 years) at particularly high risk of opioid overdose (NCHS Data Brief 2009;22:1-8).
"The present findings highlight the need to understand gender differences in pain and opioid response and how these may result in reasons for opioid use..."
Dr. Bohnert and her associates surveyed 351 individuals in a large residential addictions treatment center. Of these 351, 24% were female. Alcohol was the primary substance for seeking treatment in 30.2%, followed by heroin (19.4%), cocaine (16%), marijuana (9.7%), other opiates (4%), and other/missing (21%).
Primary analyses were restricted to 238 patients (68%), who reported nonmedical use of prescription opioids in the previous month, based on responses to the 17-item Current Opioid Misuse Measure (COMM).
Overall, 66% of respondents reported using nonmedical prescription opioids for reasons other than pain relief, such as to get high or relax, compared with 34% who were motivated to use opioids only for pain relief, Dr. Bohnert reported.
Respondents who used opioids for non–pain relief reasons were significantly more likely to be heavy opioid users (43% vs. 11%), defined as a response of "very often" on any of six core COMM items.
Patients who used opioids for reasons other than pain were significantly more likely to be female (33.3% vs. 16.5%), and white (77% vs. 59.3%), and to have a history of overdose (40.7% vs. 21.3%), she said. The association remained significant for all three variables after adjustment. Notably, prior research suggests women might have a more robust response to analgesics.
"The present findings highlight the need to understand gender differences in pain and opioid response and how these may result in reasons for opioid use," Dr. Bohnert wrote.
In adjusted analyses, patients who turned to prescription opioids for non–pain relief reasons had significantly increased odds of having used barbiturates (odds ratio 6.44), other sedatives (OR 5.80), and heroin (OR 4.08) in the past 30 days, although cocaine and cannabis use were similar.
Current suicidal ideation also was similar between groups, although overall mental health and depressive symptoms were more common in the non–pain relief group, suggesting they had poorer mental health.
Patients using opioids for non–pain relief reasons and those motivated by pain relief alone had similar pain severity scores (3.0 vs. 2.9) on the West Haven–Yale Multidimensional Pain Inventory, Dr. Bohnert observed.
"Thus, assessment of pain level or pain conditions will not necessarily distinguish between individuals whose opioid use is strictly related to pain care and individuals who use at least some of the time for other reasons," she said.
The authors concluded that the high rate of nonmedical opioid use observed in the sample "may signal an emerging and potentially critical issue in addiction treatment programs."
Dr. Bohnert and her colleagues called for future research to explore how diversion behaviors relate to motives for opioid use, and to examine differences in the success of addictions and pain management treatments between those using nonmedical opioids for reasons other than pain and those using for pain relief only.
Dr. Bohnert and her coauthors reported having no financial disclosures. Grants from the National Institutes of Health and Department of Veterans Affairs, in addition to funding from the University of Michigan, were used in the development of the investigators’ article.