A Typology of Predictive Risk Factors for Non-Adherent Medication-Related Behaviors among Chronic Non-Cancer Pain Patients Prescribed Opioids: A Cohort Study

Authors

Amy Peacock, University of New South Wales
Louisa Degenhardt, University of New South WalesFollow
Gabrielle Campbell, University of New South Wales
Briony K. Larance, University of WollongongFollow
Suzanne Nielsen, University of New South Wales
Wayne Hall, University of Queensland
Richard P. Mattick, University of New South WalesFollow
Raimondo Bruno, University of Tasmania

RIS ID

131346

Publication Details

Peacock, A., Degenhardt, L., Campbell, G., Larance, B., Nielsen, S., Hall, W., Mattick, R. P. & Bruno, R. (2016). A Typology of Predictive Risk Factors for Non-Adherent Medication-Related Behaviors among Chronic Non-Cancer Pain Patients Prescribed Opioids: A Cohort Study. Pain Physician, 19 (3), E421-E434.

Abstract

BACKGROUND: There has been no previous prospective examination of the homogeneity of chronic non-cancer pain (CNCP) patients in risk factors for non-adherent opioid use. OBJECTIVES: To identify whether latent risk classes exist among people with CNCP that predict non-adherence with prescribed opioids. STUDY DESIGN: Prospective cohort study. METHODS: The 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. RESULTS: A 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. LIMITATIONS: Risk factor onset prior to non-adherent behavior cannot be determined. CONCLUSIONS: Clusters 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.