Adult Use of Prescription Opioid Pain Medications — Utah, 2008

CA Porucznik, PhD; BC Sauer, PhD; EM Johnson, MPH; J Crook; J Wrathall, MPH; JW Anderson, MPH; RT Rolfs, MD

Morbidity and Mortality Weekly Report. 2010;59(6):153

Abstract and Introduction

Introduction

Fatal and nonfatal overdoses from prescription pain medications have increased in recent years in Utah and throughout the nation.^[1,2] In 2008, the Utah Department of Health added 12 questions to the state's Behavioral Risk Factor Surveillance System (BRFSS) survey to better understand how state residents obtain and use prescription pain medication. Findings from the survey indicated that an estimated 20.8% of Utah adults aged ≥18 years had been prescribed an opioid pain medication during the preceding 12 months. Of those prescribed an opioid pain medication, 3.2% reported using their medication more frequently or in higher doses than had been directed by their doctor; 72.0% reported having leftover medication, and 71.0% of those with leftover medication reported that they had kept the medication. Approximately 1.8% of all adults reported using prescription opioids that had not been prescribed to them. In 2009, the Utah Department of Health published a set of guidelines to reduce morbidity, mortality, and disability associated with misuse or abuse of prescription drugs, especially narcotics. The guidelines include recommendations that providers 1) counsel patients to dispose of unused medication properly once the pain has resolved and 2) prescribe no more than the number of doses needed based on the usual duration of pain severe enough to require opioids for that condition.^[3]

BRFSS conducts state-based, random-digit–dialed telephone surveys of the noninstitutionalized U.S. civilian population aged ≥18 years, collecting data on health conditions and health risk behaviors. The Utah BRFSS is conducted in the state's 12 health districts; rural health districts with smaller populations are sampled at higher rates than urban health districts with larger populations.^[4] This oversampling of less populated districts is intended to produce reliable estimates for commonly used measures within each district. In 2008, the Utah Department of Health added 12 questions regarding use of prescription pain medications to the state BRFSS survey.* For this analysis, only responses regarding opioid pain medications are included in the results. In 2008, a total of 5,330 respondents were interviewed for the Utah BRFSS. The overall Council of American Survey Research Organizations response rate for Utah in 2008 was 63.8%. Percentages were weighted by age, race, and sex to mirror the Utah adult population aged ≥18 years. Statistical significance of differences was determined by chi-square test.

In 2008, 20.8% of participants reported using at least one prescribed opioid medication during the preceding 12 months.^† Of those who reported being prescribed an opioid, 71.0% said they were prescribed the drug for short-term pain, 14.7% said they were prescribed the drug for long-term pain, and 14.4% said they were prescribed the drug for both short-term and long-term pain.^§ Receiving prescription opioids was more common among adults aged 35–64 years and most common among those aged 45–54 years (Figure).

(Enlarge Image)

Figure.

Percentage of respondents aged ≥18 years* who reported receiving a prescription opioid medication in the preceding 12 months, by type of pain and age group — Behavioral Risk Factor Surveillance System, Utah, 2008
* N = 5,330.
^† 95% confidence interval.

Of respondents prescribed at least one opioid during the preceding 12 months, 72.0% had leftover medication^¶ from their most recently filled prescription. Of those with leftover medication, 71.0% reported that they had kept the medication,** 25.2% had disposed of the medication, and 2.3% had given the medication to someone else (Table). Among respondents, 3.2% of those who had received a prescription opioid reported using the medication more frequently or in higher doses than directed by their doctor.^††

In 2008, 1.8% of BRFSS respondents reported using prescription opioid medication that had not been prescribed for them. Of those respondents, 97.0% said they obtained the medication from a friend or relative, and 72.4% said they obtained it to relieve pain. When asked how the medication was obtained, 85.2% said the medication was given to them, 9.8% said the medication was taken without the knowledge or permission of the owner, and 4.1% said it was purchased (Table).^§§ Persons aged 35–44 years were most likely to report using opioid medication that was not prescribed for them. The percentages of males and females reporting this behavior were approximately the same for all age groups with no statistically significant differences by sex.

Of respondents who reported they had been prescribed an opioid pain medication in the preceding 12 months, hydrocodone was the opioid most often prescribed (69.3% [95% confidence interval {CI} = 65.4%–73.0%]), followed by oxycodone (27.5% [CI = 23.7%–31.4%]). Of respondents who said their opioid prescription was for short-term pain, 71.0% (CI = 66.4%–75.6%) reported being prescribed hydrocodone, compared with 60.1% (CI = 51.7%–68.4%) of persons who said their prescription was for long-term pain (p = 0.01).

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Abstract and Introduction
Editorial Note
References
Sidebar

* Available at http://health.utah.gov/opha/publications/brfss/questionnaires/08utbrfss.pdf.
^† In response to the questions, "In the past year, did you use any pain medications that were prescribed to you by a doctor?" and "In the past year, what pain medications were prescribed to you by a doctor?" All reported pain medications were noted. For this analysis, only prescription opioids were included.
^§ Percentages do not add to 100.0% because of rounding.
^¶ In response to the question, "The last time you filled a prescription for pain medication was there any medication left over?"
** In response to the question, "What did you do with the leftover prescription medication?"
^†† In response to the question, "The last time you filled a prescription for pain medication, did you use any of the pain medication more frequently or in higher doses than directed by a doctor?"
^§§ In response to the question, "How did you obtain the prescription pain medication from this source [given to you, purchased, or taken without the person's knowledge or permission]?"

Table. Percentage of respondents aged ≥18 years who reported using a prescription opioid medication in the preceding 12 months, by reported medication-related behaviors — Behavioral Risk Factor Surveillance System, Utah, 2008
Behavior	No.*	%^†	(95% CI^§)
Used opioid pain medication prescribed to respondent by a doctor	5,330	20.8	(19.2–22.3)
For last prescription fill, used opioid medication more frequently or in higher doses than prescribed	1,058	3.2	(1.6–4.7)
For last opioid prescription fill, had leftover medication	1,058	72.0	(68.3–75.7)
What did respondent do with leftover medication?	751
Disposed of it		25.2	(21.0–29.5)
Gave it to someone else		2.3	(0.1–4.5)
Kept it		71.0	(66.4–75.6)
Other		1.5	(0.8–2.2)
For last opioid prescription fill, what type of pain was the indicated treatment?	1,058
Short-term pain		71.0	(67.3–74.6)
Long-term pain		14.7	(12.2–17.2)
Both		14.4	(11.4–17.3)
Used opioid pain medications not prescribed to respondent	5,330	1.8	(1.4–2.3)
Reasons for using opioid pain medication not prescribed to respondent (multiple responses permitted)	93
To relieve pain		72.4	(57.9–81.7)
For fun		15.3	(0.8–20.5)
To relieve anxiety		3.7	(0.6–5.5)
To relieve other physical symptom		2.2	(0–5.4)
Other		10.5	(9.5–29.2)
From whom did respondent obtain the opioid pain medication?	93
Friend or relative		97.0	(94.3–99.8)
Acquaintance		1.8	(0–4.3)
Other		1.2	(0–2.6)
How was the opioid pain medication obtained?	93
Given without charge		85.2	(73.3–97.2)
Took without knowledge or permission of owner		9.8	(0–20.7)
Purchased		4.1	(0–10.0)
Other		0.9	(0.4–1.4)

* Weighted by age, race, and sex to mirror the Utah adult population aged ≥18 years.
^† Subgroup percentages might not add to 100.0% because of rounding.
^§ Confidence interval.

Box. Measures to prevent misuse of opioid prescription medications
Providers can reduce the amount of opioid medication available for nonmedical use by Using opioid medications for acute or chronic pain only after determining that alternative therapies do not deliver adequate pain relief. The lowest effective dose of opioids should be used. Reserving use of long-acting or sustained-release opioids (e.g., OxyContin or methadone) for the treatment of long-term pain. Seeking specialty consultation if patients continue to experience severe pain without functional improvement despite treatment with opioids. Periodically requesting a report on the prescribing of opioids to their patients by other providers. Such reports generally are available from the state prescription drug monitoring program.
State and federal agencies can reduce the risks resulting from misuse of opioid analgesics by Making substance abuse treatment services widely available. Monitoring Medicaid prescription claims information for signs of inappropriate use of opioid medication (e.g., multiple prescriptions for the same medication from different physicians), and notifying the physicians that the patient might be misusing the medication. Proactively using state prescription drug monitoring programs to identify patients and providers with signs of inappropriate use, prescribing, or dispensing of opioid medications.

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