Most opioid users with chronic pain in a survey said they don’t worry about overdosing and admitted that they lacked good understanding of naloxone, a researcher reported.
In two groups of opioid medication users — those with known opioid use disorder (OUD) and those with chronic pain — 60% of the latter said they were “not at all concerned about overdosing” versus 28.9% of the OUD group, who essentially served as controls, according to Matthew Ellis, MPH, a doctoral candidate at Washington University in St. Louis.
In addition, 62.1% of chronic pain users said they felt they had “no risk” of overdosing versus 19.1% of the OUD group, Ellis reported in a poster at the virtual PAINWeek meeting.
And while 84.1% of the OUD group said they could recognize overdose symptoms, only 47.1% of chronic pain users said they could.
Two-thirds of all users reported at least one high risk comorbidity, such as mental health conditions, sleep disorders, and chronic obstructive pulmonary disease (COPD).
“Despite having multiple risk factors for opioid overdose, [chronic pain users] had low perceived risk or concern of overdose,” Ellis’ group wrote.
“It surprises me given the reach of the opioid epidemic,” Ellis added.
The researchers sought to “compare risk, awareness and perceptions associated with naloxone” across two populations “considered to be at increased risk of opioid overdose,” according to the poster. Citing CDC opioid prescribing guidelines, Ellis noted multiple risk factors are associated with overdose, so populations with varying traits may need naloxone.
Each group received online questionnaires to each group in June. The OUD group consisted of 152 treatment-seeking people with no history of chronic pain who had not previously participated in a national opioid study.
The chronic pain group featured 190 people identified via a market research firm as being diagnosed, or treated for, chronic pain (at least 3 months), and taking a high-dose prescription opioid or co-prescribed an opioid and a benzodiazepine. Participants were excluded for prior OUD history, illicit drug use, or healthcare employment.
Among the chronic pain group, 73.2% were on a high dose (at least 50 morphine milligram equivalents daily) but only 5.8% called their prescription a “high dosage.” This finding also was surprising, according to Ellis: “They didn’t think they were on high doses even though they were. They thought their own regimen was safe” and that they were not at risk of overdose, he said, even if they knew others who had overdosed.
While 52.6% were using benzodiazepines along with opioids, less than half (47%) knew of the increased risks for overdose and death associated with combining the two medications.
Regarding naloxone awareness and perceptions, 98% of the OUD group was aware of naloxone versus 75.3% of the chronic pain group. Just 13.5% of the chronic pain group considered themselves to have good knowledge of naloxone.
“The chronic pain group had high awareness of what naloxone was, but few knew anything about it,” Ellis said.
Also, 71.8% of chronic pain users believed they did not need to regularly keep naloxone on-hand versus 48.3% of the OUD group. When asked about the likelihood of getting naloxone in the future, 22.6% of chronic pain users said ‘yes’ versus 35% of the OUD group. But medical providers had never encouraged or recommended securing the treatment for 65.5% of the chronic pain group versus 37% of the OUD group.
“Interventions surrounding naloxone knowledge and access may need to stem from different sources,” the researchers wrote.
Ellis said he would eventually like to see everyone in the OUD group report they need to have naloxone on them. “We still need to get naloxone into the hands of individuals who have opioid addiction,” he said.
Respondents were asked about their trust of healthcare professionals, with just between 16%-22% of the OUD group stating they considered the heatlhcare providers to be extremely knowledgeable versus 65% of the chronic pain users.
Chronic pain users were more likely to secure naloxone from a provider (34.7%) or emergency services/first responder (26.7%) than the OUD group. The OUD group was more likely to get the treatment from a mental health/addiction resource (32.9%) or community program (17.1%).
The OUD group reported experiencing some stigma from healthcare professionals because of their opioid use more often than the chronic pain group (72.5% vs 33.7%).
The researchers are planning to extend the study to examine who is most at risk, by looking at the influences of factors such as kidney disease, mental health disorders, and COPD, Ellis said.
The study was funded by Emergent BioSolutions.