title: A Typology of Predictive Risk Factors for Non-Adherent Medication-Related Behaviors among Chronic Non-Cancer Pain Patients Prescribed Opioids: A Cohort Study.
abstract: BACKGROUND
  There has been no previous prospective examination of the homogeneity of chronic non-cancer pain (CNCP) patients in risk factors for non-adherent opioid use.
  
  
  OBJECTIVE
  To identify whether latent risk classes exist among people with CNCP that predict non-adherence with prescribed opioids.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  The Pain and Opioids IN Treatment prospective cohort comprises 1,514 people in Australia prescribed pharmaceutical opioids for CNCP interviewed 3 months apart. Risk factors were assessed in wave 1, and non-adherent behaviors in the 3 months prior to wave 1 and wave 2. Latent class analysis was used to examine groups with differing risk profiles. Logistic regression was used to examine predictors of non-adherence.
  
  
  RESULTS
  A 4-class model was selected with classes described as: 1) Poor Physical Functioning group (27%); 2) Poor Coping/Physical Functioning group (35%); 3) Substance Use Problems group (14%); and 4) Multiple Comorbid Problems group (25%). The latter 2 groups had an increased risk of requesting increased opioid doses, early script renewals, using diverted medication, dose stock-piling, and unsanctioned dose alteration at wave 2.
  
  
  CONCLUSIONS
  Risk factor onset prior to non-adherent behavior cannot be determined.
  
  
  CONCLUSIONS
  Clusters of CNCP patients with distinct risk profiles for non-adherence exist. Each group was identified by at least one risk factor but the likelihood of non-adherent opioid use was higher in groups with particular clusters of multiple risk factors. Not all those with risk factors display non-adherence, emphasising the need for strategies to reduce risk for those patients displaying particular clusters of risks.
authors.affiliation: School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: Amy
authors.initials: A
authors.lastname: Peacock
authors.affiliation: School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Campbell
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Briony
authors.initials: B
authors.lastname: Larance
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia Drug and Alcohol Services South Eastern Sydney Local Health District.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Nielsen
authors.affiliation: School of Population Health, University of Queensland, Queensland, Australia.
authors.forename: Wayne
authors.initials: W
authors.lastname: Hall
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Mattick
authors.affiliation: School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: Raimondo
authors.initials: R
authors.lastname: Bruno
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D001315:Australia; D059350:Chronic Pain / Q000188:drug therapy* / Q000523:psychology*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications
chemical_list: D000701:Analgesics, Opioid