• A Taylor Thomas, Kara G Fields, Alan D Kaye, and Richard D Urman.
• Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston MA.
• Pain Physician. 2022 Jul 1; 25 (4): E669-E679.

BackgroundPrescription opioid misuse is an ongoing epidemic in the United States. Though the number of people misusing prescription opioids is declining, the prevalence of abuse and dependence remains stable. This highlights the need to identify and intervene in factors leading to the escalation of prescription opioid misuse.ObjectivesThe aim of this study was to explore the association of prescription opioid-specific misuse factors such as pill source, misuse motivation, and misuse habits with abuse and dependence.Study DesignA retrospective cross-sectional study.SettingParticipants in the 2015 to 2018 National Survey on Drug Use and Health (NSDUH) reporting prescription opioid misuse in the past 12 months.MethodsSimple and multivariable logistic regression were used to estimate the association of prescription opioid-specific misuse factors with prescription opioid abuse and dependence, which were determined by participant responses to screening questions according to DSM-IV criteria.ResultsAfter multivariable adjustment, prescription opioid abuse was associated with use in greater amounts than prescribed and misuse for 3-19 days in the past month, whereas dependence was associated with use in greater amounts and more often than prescribed, and misuse for 6 or more days in the past month. Initiating misuse in the past year and misuse without one's own prescription in the past year were associated with lower odds of opioid dependence.LimitationsOnly associations and not causal relationships can be claimed between the factors and outcomes. Second, the survey relies on self-reported data, and there is likely both underreporting and overreporting, leading to bias towards the null. The survey target population was civilian, so it excluded individuals living in institutional group quarters such as hospitals, treatment facilities, nursing homes, and prisons. This study does not differentiate between prescription opioids used for acute versus chronic pain.ConclusionsStudy results suggest the importance of the frequency of prescription opioid misuse as a possible risk factor for dependence and emphasize the need to monitor for misuse even in instances of acute pain.

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