Gender Differences in Risk Factors for Aberrant Prescription Opioid Use

Pain Management Center, Departments of Anesthesia and Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02467, USA.
The journal of pain: official journal of the American Pain Society (Impact Factor: 4.01). 11/2009; 11(4):312-20. DOI: 10.1016/j.jpain.2009.07.016
Source: PubMed


This is a longitudinal predictive study to examine gender differences in the clinical correlates of risk for opioid misuse among chronic pain patients prescribed opioids for pain. Two hundred seventy-five male and 335 female patients prescribed opioids for chronic noncancer pain were asked to complete a series of baseline questionnaires, including the revised Screener and Opioid Assessment for Pain Patients (SOAPP-R). After 5 months, the subjects were administered a structured prescription drug use interview (Prescription Drug Use Questionnaire; PDUQ) and submitted a urine sample for toxicology assessment. Their treating physicians also completed a substance misuse behavior checklist (Prescription Opioid Therapy Questionnaire; POTQ). At 5-month follow-up, women showed higher scores on the PDUQ (P < .05), whereas men had a higher incidence of physician-rated aberrant drug behavior on the POTQ (P < .05). An item analysis of the SOAPP-R, PDUQ, and POTQ showed that women tended to score higher on items relating to psychological distress, whereas the male patients tended to report having more legal and behavioral problems. These results suggest that risk factors associated with prescription opioid misuse may differ between men and women. PERSPECTIVE: Understanding gender differences in substance abuse risk among chronic pain patients is important for clinical assessment and treatment. This study suggests that women are at greater risk to misuse opioids because of emotional issues and affective distress, whereas men tend to misuse opioids because of legal and problematic behavioral issues.

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Available from: Stephen F Butler
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    • "Women also reported higher levels of worst pain (in the last week) and greater physical and social impairments from pain, whereas men endorsed more specific aberrant behaviors , such as increasing their dose without authorization. These differences are consistent with prior reports of features of chronic pain specific to men and women (Fillingim et al., 2003a; Chenot et al., 2008; Jamison et al., 2010). With regard to aberrant behaviors, differential patterns of endorsement did emerge. "
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    ABSTRACT: Background: The characteristics of patients with co-occurring chronic pain and prescription opioid abuse have not been well described, and even less is known about differences between men and women in this population. Objectives: This study evaluated sex differences in the demographic, diagnostic, and behavioral attributes of patients with chronic pain and opioid abuse. Methods: Data were collected via self-report and semistructured clinical interviews from 162 patients (120 men and 42 women) who screened for a study investigating the abuse liability of prescription opioids. Results: There were no differences between men and women in age, race, education, marital status, or employment status. Participants had used prescription opioids for 5.4 ± 6.7 years. The majority of participants (60%) had low back pain in addition to opioid dependence as defined by the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition. More women reported more arthritic pain than men, but otherwise there were no differences in types of pain. Pain exerted a greater effect in women on mood, walking ability, and social relations. Men reported more of certain aberrant behaviors, including abuse of alcohol or illicit drugs, unauthorized dose increases, contact with street culture, and being arrested by police. Women were more depressed than men. Conclusions: The demographic profile of opioid-abusing patients with chronic pain presenting for treatment in a clinical trial was similar between sexes; however, some important differences were observed. Women reported more psychiatric comorbidity and endorsed greater pain-related physical and social impairment. Men reported more aberrant behaviors. These differences suggest that men with chronic pain and opioid abuse/dependence may benefit by closer monitoring of aberrant behaviors whereas women may benefit from closer attention paid to physical and psychological effects of pain.
    Full-text · Article · Oct 2014 · Journal of Addiction Medicine
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    • "Previous studies indicate that younger chronic pain patients (under age 65) are at higher risk for opioid abuse [18,46]. With respect to gender, women with chronic pain who reported more emotional issues and affective distress were at increased risk for opioid misuse, whereas men with legal problems tended to predict misuse prescription opioids [47]. "
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    ABSTRACT: Substance use disorders (SUDs), whether active or in remission, are often encountered in patients with chronic nonmalignant pain. Clinicians are challenged when managing chronic pain while facing substance abuse issues during the course of chronic opioid therapy (COT). Further, the interrelated behavioral symptomatology of addiction and chronic pain suggests that if one disorder is untreated, effective treatment of the other in not possible. Incomplete understanding of the overlapping presentations of the two disorders, coupled with insufficient management of both conditions, leads to undertreated pain and premature discharge of SUD patients from pain treatment. In order to achieve pain relief and optimal functionality, both conditions need to be carefully managed. This paper reviews the prevalence of SUDs in chronic pain patents; the overlapping presentation of the two disorders; risk factors and stratification for addiction; identification of addiction in the chronic pain population; and suggestions for treating patients with COT, with an emphasis on relapse prevention. With appropriate assessment and treatment, COT for chronic pain patients with a history of SUD can be successful, leading to improved functionality and quality of life.
    Full-text · Article · Dec 2013 · Addiction science & clinical practice
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    • "Many studies have shown that workers who use prescription opioids take more days off work, specifically, 2.2 days of work lost per month, which is more than 2.5 times the average worker [Wasan et al., 2005; Strassels, 2009; Volinn et al., 2009; Jamison et al., 2010]. In addition, these issues may affect productivity, presenteeism, and more medical claims resulting in increased economic burdens on the employers [Wasan et al., 2005; Strassels, 2009]. "
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    ABSTRACT: Objective: To infer whether work-related injuries may impact opioid-related deaths. Methods: Descriptive comparisons were done using data from the Utah Department of Health, the Office of Medical Examiners, and the Labor Commission on all Utah residents who died from opioid-related deaths from 2008 to 2009. Results: The majority of decedents (145 of 254, 57%) had at least one prior work-related injury. Demographics were similar regardless of work injury status. However, lack of high school diploma (18% vs. 7%, P < 0.001), prevalence of mental illness (50% vs. 15%, P < 0.001), tobacco (61% vs. 12%, P < 0.001), alcohol (87% vs. 28%, P < 0.001), and illicit drug (50% vs. 4%, P < 0.001) use were all substantially higher than the background population. Conclusion: A detailed history and screening for mental illness and substance abuse, including tobacco use, among injured workers may be helpful in avoiding potential opioid-related deaths.
    Full-text · Article · Mar 2013 · American Journal of Industrial Medicine
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