As many as one in 10 adults prescribed opioids for chronic pain will go on to experience opioid dependency or opioid use disorder, worrying new research has suggested.
A team from the University of Bristol carried out a scientific review of 148 studies, enrolling over 4.3 million adult chronic pain patients treated with prescription opioid painkillers.
The research, published in the journal Addiction, also found nearly one in three patients showed symptoms of dependence and opioid use disorder.
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By comparison, companies such as Oxycontin manufacturer Purdue Pharma have claimed that fewer than 1% of opioid prescriptions result in problems for patients, the team argued.
The new review, funded by the National Institute for Health and Care Research (NIHR), makes clear that such claims “greatly understate” the risk of opioid misuse and addiction.
It is estimated that chronic pain affects up to a quarter of adults globally, and about a third are prescribed opioid analgesics. In England alone, 15.5 million people have chronic pain.
Extrapolating the research findings, this suggests that about half a million patients in England could be dependent on opioid painkillers.
The researchers divided the 148 studies into four general categories, depending on how the studies defined problematic opioid use.
These included studies that identified problematic opioid use through diagnostic codes (formal diagnoses using precise definitions) and studies that looked for behaviours indicating dependence and opioid use disorder, such as craving, tolerance, or withdrawal.
They also examined studies that looked for inappropriate or concerning behaviour, such as seeking early refills, repeated dose escalations, or frequently lost prescriptions and studies that looked for characteristics that might increase the risk of developing opioid dependence or opioid use disorder in the future.
Dependence and opioid use disorder was found in 3%, or nearly one in 10 patients. Signs and symptoms of dependence and opioid use disorder was found in 6%, or nearly one in three patients.
Aberrant behaviour was found in 22%, or more than one in five patients. At risk of dependence and opioid use disorder was found in 4%, or nearly one in eight patients.
Professor Kyla Thomas, professor of public health medicine at the University of Bristol and the study’s lead author, said: “Clinicians and policy makers 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. Knowing the size of the problem is a necessary step to managing it.”
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