Thomas, Kyla H and Dalili, Michael N and Cheng, Hung-Yuan and Dawson, Sarah and Donnelly, Nick and Higgins, Julian P T and Hickman, Matthew (2024) Prevalence of problematic pharmaceutical opioid use in patients with chronic non-cancer pain: a systematic review and meta-analysis. Addiction, Early online, https://doi.org/10.1111/add.16616.
External website: https://onlinelibrary.wiley.com/doi/10.1111/add.16...
BACKGROUND AND AIMS: Chronic non-cancer pain (CNCP) is one of the most common causes of disability globally. Opioid prescribing to treat CNCP remains widespread, despite limited evidence of long-term clinical benefit and evidence of harm such as problematic pharmaceutical opioid use (POU) and overdose. The study aimed to measure the prevalence of POU in CNCP patients treated with opioid analgesics.
METHOD: A comprehensive systematic literature review and meta-analysis was undertaken using MEDLINE, Embase and PsycINFO databases from inception to 27 January 2021. We included studies from all settings with participants aged ≥ 12 with non-cancer pain of ≥ 3 months duration, treated with opioid analgesics. We excluded case-control studies, as they cannot be used to generate prevalence estimates. POU was defined using four categories: dependence and opioid use disorder (D&OUD), signs and symptoms of D&OUD (S&S), aberrant behaviour (AB) and at risk of D&OUD. We used a random-effects multi-level meta-analytical model. We evaluated inconsistency using the I statistic and explored heterogeneity using subgroup analyses and meta-regressions.
RESULTS: A total of 148 studies were included with > 4.3 million participants; 1% of studies were classified as high risk of bias. The pooled prevalence was 9.3% [95% confidence interval (CI) = 5.7-14.8%; I = 99.9%] for D&OUD, 29.6% (95% CI = 22.1-38.3%, I = 99.3%) for S&S and 22% (95% CI = 17.4-27.3%, I = 99.8%) for AB. The prevalence of those at risk of D&OUD was 12.4% (95% CI = 4.3-30.7%, I = 99.6%). Prevalence was affected by study setting, study design and diagnostic tool. Due to the high heterogeneity, the findings should be interpreted with caution.
CONCLUSIONS: Problematic pharmaceutical opioid use appears to be common in chronic pain patients treated with opioid analgesics, with nearly one in 10 experiencing dependence and opioid use disorder, one in three showing signs and symptoms of dependence and opioid use disorder and one in five showing aberrant behaviour.
B Substances > Opioids (opiates)
E Concepts in biomedical areas > Medical substance > Prescription drug (medicine / medication)
G Health and disease > Substance use disorder (addiction) > Drug use disorder
J Health care, prevention, harm reduction and treatment > Risk and protective factors > Risk factors
J Health care, prevention, harm reduction and treatment > Patient / client care management
J Health care, prevention, harm reduction and treatment > Treatment and maintenance > Treatment issues (pain management)
VA Geographic area > International
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