• Amy Peacock, Louisa Degenhardt, Gabriella Campbell, Briony Larance, Suzanne Nielsen, Wayne Hall, Richard P Mattick, and Raimondo Bruno.
• School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia.
• Pain Physician. 2016 Mar 1; 19 (3): E421-34.

BackgroundThere has been no previous prospective examination of the homogeneity of chronic non-cancer pain (CNCP) patients in risk factors for non-adherent opioid use.ObjectivesTo identify whether latent risk classes exist among people with CNCP that predict non-adherence with prescribed opioids.Study DesignProspective cohort study.MethodsThe Pain and Opioids IN Treatment prospective cohort comprises 1,514 people in Australia prescribed pharmaceutical opioids for CNCP interviewed 3 months apart. Risk factors were assessed in wave 1, and non-adherent behaviors in the 3 months prior to wave 1 and wave 2. Latent class analysis was used to examine groups with differing risk profiles. Logistic regression was used to examine predictors of non-adherence.ResultsA 4-class model was selected with classes described as: 1) Poor Physical Functioning group (27%); 2) Poor Coping/Physical Functioning group (35%); 3) Substance Use Problems group (14%); and 4) Multiple Comorbid Problems group (25%). The latter 2 groups had an increased risk of requesting increased opioid doses, early script renewals, using diverted medication, dose stock-piling, and unsanctioned dose alteration at wave 2.LimitationsRisk factor onset prior to non-adherent behavior cannot be determined.ConclusionsClusters of CNCP patients with distinct risk profiles for non-adherence exist. Each group was identified by at least one risk factor but the likelihood of non-adherent opioid use was higher in groups with particular clusters of multiple risk factors. Not all those with risk factors display non-adherence, emphasising the need for strategies to reduce risk for those patients displaying particular clusters of risks.

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