Self-reported challenges obtaining ongoing prescription opioids among Australians with chronic non-cancer pain

Abstract

Background: Policies to address opioid-related harms include strategies to reduce opioid prescribing for new and ongoing pain management. Concerns have been raised that people with chronic non-cancer pain (CNCP) may be adversely affected by prescribing restrictions, and by involuntary tapering and cessation of opioids. We describe self-reported challenges obtaining prescription opioids among people prescribed opioids long-term for CNCP and explore associations with participant and treatment characteristics.

Methods: This cross-sectional study analysed data from a longitudinal cohort study of Australians prescribed restricted opioids for CNCP. In 2018, 861 participants who took part in Year 5 follow-up and who also reported past 12-month opioid use were asked about challenges obtaining opioid prescriptions, including prescriber access-related difficulties obtaining prescriptions or having opioids tapered or ceased involuntarily. Associations between challenges and demographics, treatment characteristics including daily opioid dose as oral morphine equivalent milligrams (OME mg/day), substance use disorder (SUD), and opioid dependence were assessed.

Results: Overall, 285 (31%) participants reported at least one challenge, predominantly prescriber access-related difficulties (n=177/285; 62%). Prescriber access-related difficulties were associated with younger age (adjustedOR 0.94 per year increase, 95%CI 0.93-0.96), and past 12-month pharmaceutical opioid dependence (adjustedOR 2.25, 95%CI 1.33-3.80). Involuntary opioid tapering or cessation was reported by 73 participants (26% of those reporting challenges) and was associated with lifetime SUD diagnosis (adjustedOR 2.15, 95%CI 1.15-3.90), and opioid doses of ≥200 OME mg/day (adjustedOR 2.41, 95%CI 1.18-4.88).

Conclusion: One-third of participants with CNCP reported experiencing challenges obtaining prescriptions for opioids or having their opioid medicines involuntarily reduced. Given increasing restrictions to opioid access, it is important that strategies to reduce opioid-related harms are balanced against the current treatment needs of people prescribed opioids long-term for CNCP.

Keywords: Chronic non-cancer pain; Chronic pain; Opioids; Policy analysis; Policy changes; Prescription opioids.