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The Role of Opioid Prescription in Incident Opioid Abuse and Dependence Among Individuals With Chronic Noncancer Pain: The Role of Opioid Prescription

Edlund, Mark J. MD, PhD*; Martin, Bradley C. PharmD; Russo, Joan E. PhD; DeVries, Andrea PhD§; Braden, Jennifer B. PhD; Sullivan, Mark D. MD

The Clinical Journal of Pain: July 2014 - Volume 30 - Issue 7 - p 557–564
doi: 10.1097/AJP.0000000000000021
Original Articles

Objective: Increasing rates of opioid use disorders (OUDs) (abuse and dependence) among patients prescribed opioids are a significant public health concern. We investigated the association between exposure to prescription opioids and incident OUDs among individuals with a new episode of a chronic noncancer pain (CNCP) condition.

Methods: We utilized claims data from the HealthCore Database for 2000 to 2005. The dataset included all individuals aged 18 and over with a new CNCP episode (no diagnosis in the prior 6 mo), and no opioid use or OUD in the prior 6 months (n=568,640). We constructed a single multinomial variable describing prescription on opioid days supply (none, acute, and chronic) and average daily dose (none, low dose, medium dose, and high dose), and examined the association between this variable and an incident OUD diagnosis.

Results: Patients with CNCP prescribed opioids had significantly higher rates of OUDs compared with those not prescribed opioids. Effects varied by average daily dose and days supply: low dose, acute (odds ratio [OR]=3.03; 95% confidence interval [CI], 2.32, 3.95); low dose, chronic (OR=14.92; 95% CI, 10.38, 21.46); medium dose, acute (OR=2.80; 95% CI, 2.12, 3.71); medium dose, chronic (OR=28.69; 95% CI, 20.02, 41.13); high dose, acute (OR=3.10; 95% CI, 1.67, 5.77); and high dose, chronic (OR=122.45; 95% CI, 72.79, 205.99).

Conclusions: Among individuals with a new CNCP episode, prescription opioid exposure was a strong risk factor for incident OUDs; magnitudes of effects were large. Duration of opioid therapy was more important than daily dose in determining OUD risk.

*RTI International, Behavioral Health Epidemiology, Research Triangle Park, NC

Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR

Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA

§HealthCore Inc., Wilmington, DE

Supported by NIDA R01 DA022560-01. The authors declare no conflict of interest.

Reprints: Mark J. Edlund, MD, PhD, 3335 Longbow Dr, Twin Falls, ID 83301 (e-mail:

Received July 17, 2012

Accepted August 2, 2013

© 2014 by Lippincott Williams & Wilkins