Pain linked to non-medical prescription opioid use in young adults

Physical pain—often "self-medicated" without help from healthcare professionals—is an important contributor to non-medical prescription opioid (NMPO) use by young adults, suggests a study in the Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine (ASAM).

Young men with severe untreated pain are at especially high risk of frequent NMPO use, according to the new research, led by Brandon D.L. Marshall, PhD, of Brown University School of Public Health. Dr. Marshall comments, "Sex-specific patterns of pain and experiences interacting with health professionals could conceivably impact the way men and women report pain to health care providers, and thus the way young adults with severe physical pain are treated."

Risk Factors for Frequent NMPO Use Differ for Young Men and Women

The study included 199 young adult NMPO users enrolled in the Rhode Island Young Adult Prescription Drug Study (RAPiDS), an ongoing study of opioid overdose prevention. Non-medical prescription opioid use refers to using opioids without a prescription or in a way other than prescribed. The NMPO users were a racially/ethnically diverse group; about two-thirds were male. About one-third had a previous opioid overdose.

One hundred nineteen participants reported using NMPOs at least weekly. Dr. Marshall and colleagues evaluated history of pain, pain treatment, and other factors associated with being a frequent NMPO user.

Eighty-five percent of young adult NMPO users said they had experienced some type of injury or health condition that put them in severe pain—most commonly leg or back pain. Consistent with previous studies, most participants said they had used NMPOs to treat physical pain.

For the subjects reporting pain, there was evidence of inadequate pain treatment. About one-fourth of males and one-third of females said that a health professional had denied them medication to treat severe pain. Of those who did not seek medical treatment, many said they could "self-medicate" their pain and/or believed they would be denied prescription pain medications. Others said they didn't like seeking medical help or didn't have health insurance.

After adjustment for other factors, young men with higher pain scores were significantly more likely to report frequent NMPO use. White race was also a risk factor for frequent NMPO use among men. For women, older age and non-medical use of benzodiazepines—a class of sedative drugs—were risk factors for frequent NMPO use. In contrast, established risk factors for opioid use disorder (OUD), such as mental health disorders or street drug use, were not associated with frequent NMPO use.

The United States is in the midst of an opioid epidemic—one study estimated 20,000 deaths related to prescription opioid overdose in 2015 alone. Young adults who are frequent users of NMPOs are at especially high risk for overdose. Recent studies have found high rates of untreated physical pain among patients with OUD.

This study provides new evidence that physical pain—and using prescription opioids for self-treatment of pain—is common among young adults with NMPO use. The factors associated with frequent NMPO use appear to differ by sex: severe pain is an important risk factor in young men, while benzodiazepine use is a more important factor in women.

The study also provides insights into the reasons why some young adult NMPO users don't seek medical care for severe pain. Especially if labeled as "drug seekers," they may have difficulty receiving recommended pain treatment, or may self-medicate without asking for help. Dr. Marshall adds, "Harm reduction and pain management interventions for young adults may need to account for sex-specific drivers of frequent NMPO use, including self-medicating with prescription opioids to manage severe pain."