The reasons for prescription opioid abuse

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Distress and pain are the key reasons people are taking opioids in higher doses than prescribed or without a prescription, new research shows

A study led by Monash University researchers, in collaboration with Turning Point and Ambulance Victoria, has shown that these are the major reasons for extramedical prescription use of opioids.

Using data collected during ambulance attendances between 2013 and 2018, the study analysed paramedic records relating to the overuse of oxycodone, which is seen in most overdose cases and is the most commonly prescribed opioid used to treat pain, as well as tapentadol, which has been associated with lower levels of misuse or harms.

The study, led by Associate Professor Suzanne Nielsen, found strong similarities across both drug types but surprisingly highlights that people self-medicate due to a complex mix of mental health issues, chronic illness, work-related stress or family problems.

“Our analysis found patients in complex, emergency situations, seeking rapid relief from physical pain, psychological distress, social issues and/or suicidal thoughts,” the study concluded.

“These data highlight the complex needs of those experiencing harm from extramedical pharmaceutical opioid use, regardless of opioid type, and the importance of contextual factors shaping both use and subsequent harm.”

The researchers note that previous studies have largely focused on extramedical prescription opioid use in groups with substance use issues.

This study examined all people who required an ambulance following extramedical pharmaceutical opioid use and found they were most commonly in the 35-54 age group, and more harms were among women (55% of all ambulance attendances in the study). 

There were five main factors that contributed to peoples’ overuse: psychological distress (28%), physical pain (19%), social stressors (13%), unintentional non-adherence (9%) and opioid use disorder (7%), with over one fifth of cases having two or more contributing factors.

“We expected to see differences in the contexts that these two opioids were used, but we found that despite a much higher number of presentations relating to oxycodone, the actual contexts of use were surprisingly similar,” Associate Professor Nielsen said.

The findings of the study show that to reduce harms with prescription opioids, interventions are needed that address the multiple and complex needs of people with chronic pain and mental health conditions, rather than focusing only on people who use these drugs in a recreational context.

“The common narrative is that harms come from people using these drugs to ‘get high’, or that harms occur among people with drug use problems.

“This study challenges those findings. The most common contexts of use were for relief of mental health symptoms or to relieve pain, often chronic pain,” said Associate Professor Nielsen.

“In most situations these people are not intentionally trying to end their life, but they may be looking to escape from trauma or extreme distress.”

Over the past two decades there has been a dramatic increase in the number of deaths worldwide from prescription opioid use, with opioid-related deaths almost doubling in Australia in the decade since 2007.

The findings of the study have been published in Drug and Alcohol Review.

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