title: Reasons for under-use of prescribed opioid medications by patients in pain.
abstract: BACKGROUND
  With the growth in opioid therapy for the treatment of chronic pain, health care providers have focused their attention on avoiding over-use of opioid medications, specifically to avoid addiction, dependency, and other misuse. Qualitative and quantitative reviews of medication adherence, in contrast, focus primarily on why patients under-use or do not take their medications as prescribed and find nonadherence rates of approximately 25%.
  
  
  OBJECTIVE
  To identify the prevalence of under-use of opioid medications and the reasons and implications of under-use.
  
  
  METHODS
  As part of a variety of structured assessments, subjects were asked detailed questions about how they used their opioid medication in their daily lives.
  
  
  METHODS
  One hundred ninety-one veterans who received an opioid prescription for any pain problem within the 12 months before the interview.
  
  
  METHODS
  We defined a patient who under-used his/her medication as one who took less than their prescribed dose of medication and reported that pain impaired their ability to engage in normal daily activities.
  
  
  RESULTS
  Under-use of opioids (20%) was more common than over-use (9%), consistent with research on medication adherence. Patients who under-used their opioids offered the same reasons for under-use that patients report for other medications. However, while under-users reported more pain than other opioid users they filled only slightly fewer opioid prescriptions. Communication problems between patients and providers about opioids were common.
  
  
  CONCLUSIONS
  Improved communication between patients and providers and shared decision-making regarding opioid prescriptions may improve pain management and minimize the problems associated with over-prescription of opioids (i.e., diversion).
authors.affiliation: Center for Health Care Evaluation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California 94025, USA. eleanor.lewis@va.gov
authors.forename: Eleanor T
authors.initials: ET
authors.lastname: Lewis
authors.forename: Ann
authors.initials: A
authors.lastname: Combs
authors.forename: Jodie A
authors.initials: JA
authors.lastname: Trafton
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D003625:Data Collection; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders; D010146:Pain / Q000188:drug therapy*; D010817:Physician-Patient Relations
chemical_list: D000701:Analgesics, Opioid