title: Do patient-perceived pros and cons of opioids predict sustained higher-dose use?
abstract: OBJECTIVE
  Chronic opioid therapy (COT) is associated with various adverse outcomes, especially at higher doses, yet little is known about predictors of sustained higher-dose COT. This study aimed to ascertain, among higher-dose COT patients, the association of patient-perceived pros and cons of opioids with continued higher-dose use 1 year later.
  
  
  METHODS
  Patients (N=1229) in 2 large health plans prescribed ≥50 mg morphine-equivalent dose (MED) per day for chronic noncancer pain completed a survey assessing opioid benefits and harms. The Prescribed Opioid Difficulties Scale questionnaire assessed psychosocial problems, concerns, benefits, and side effects related to opioid use. Logistic regression models estimated the associations of the reported benefits and problems with higher-dose continuation (≥50 mg MED/d) versus dose reduction (<50 mg MED/d) 1 year later.
  
  
  RESULTS
  Over 80% of participants continued higher-dose opioid use at 1 year, regardless of reported problems, concerns, side effects, pain reduction, or perceived helpfulness. Higher scores on the Prescribed Opioid Difficulties Scale Problems subscale (odds ratio=0.79, 95% confidence interval, 0.68-0.92) and Concerns subscale (odds ratio=0.76, 95% confidence interval, 0.65-0.90) were negatively associated with higher-dose use 1 year later. Other baseline measures (opioid helpfulness, reduction in pain, number of side effects, and side effect bothersomeness) were not significantly associated with continued higher-dose use.
  
  
  CONCLUSIONS
  The large majority of patients continued using higher-dose opioids regardless of baseline characteristics. These findings suggest the difficulty of reducing opioid dose among chronic higher-dose opioid users.
authors.affiliation: *Psychiatry and Behavioral Sciences §Oral Medicine, University of Washington †Geriatric Research, Education, and Clinical Center, Puget Sound Veterans Affairs Medical Center ‡Group Health Research Institute, Seattle, WA ∥Kaiser Permanente Division of Research, Oakland, CA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Thielke
authors.forename: Judith A
authors.initials: JA
authors.lastname: Turner
authors.forename: Susan M
authors.initials: SM
authors.lastname: Shortreed
authors.forename: Kathleen
authors.initials: K
authors.lastname: Saunders
authors.forename: Linda
authors.initials: L
authors.lastname: Leresche
authors.forename: Cynthia I
authors.initials: CI
authors.lastname: Campbell
authors.forename: Constance C
authors.initials: CC
authors.lastname: Weisner
authors.forename: Michael V
authors.initials: MV
authors.lastname: Korff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D000704:Analysis of Variance; D001290:Attitude; D059350:Chronic Pain / Q000188:drug therapy / Q000523:psychology; D016001:Confidence Intervals; D004522:Educational Status; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders; D059408:Pain Management; D017060:Patient Satisfaction; D010361:Patients; D012737:Sex Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
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