Factors Affecting Opioid Use among Patients with Chronic Pain: Patient Attitudes vs Market Conditions

Prescription opioids are commonly used to treat chronic pain, even though non-opioid therapy is preferred for the treatment for most types of pain. Only 13.9 percent of adults have treatment for chronic pain in a given year, however, those with treatment for chronic pain account for 52.8 percent of all opioid use. Among those with chronic pain treatment, 40.5 percent use opioids. Among those who use opioids, 67.8 percent have 4 or more opioid fills. However, high dosages and long-term use of opioids are more likely to lead to opioid use disorder. Examining the factors associated with opioid use among patients with chronic pain can help us identify patients at risk of misuse of opioids.

In this study, we use data from the Medical Expenditure Panel Survey for 2013 to 2015 to examine demand and supply side factors associated with the use of opioids among non-elderly adult patients with chronic pain. The two outcome measures are having any opioid use and number of opioid fills. The key demand-side variables of interest are four questions on attitudes about health services: (1) Do not need health insurance (NONEED), (2) Health insurance is not worth the money it costs (NOTWORTH), (3) More likely to take risks than the average person (TAKERISK), and (4) Can overcome illness without help from medically trained person (OVERCOME). We examine whether opioid use differs between persons who disagree and agree with these statements using logit and ordinary least squares models.

The preliminary work has only focused on demand side factors controlling for socio-economic variables including age, sex, race, education, income, insurance and health status. Preliminary results on demand side factors show that NONEED and OVERCOME are significantly associated with opioid use. For those who believe they need health insurance, the odds of having any opioid use are 1.5 times larger than for those who do not believe they need health insurance. For those who believe they cannot overcome illness without help from a medically trained person, the odds of having any opioid use are 2.7 times larger than for those who believe they can overcome illness without help. Among adults with any opioid use, the attitude variables do not influence level of use. In future work, we will examine the effects of provider competition hypothesizing that increased physician competition leads to higher opioid use by enabling physician shopping to get more opioids. We will derive the supply side measures using data from IQVIA, AHA, and DRG Interstudy.

Our preliminary results show that attitudes about health care significantly influence the probability of any opioid use among patients with chronic pain. Measuring the relative magnitudes of the effects of supply and demand side factors is an important step in efforts to reduce the use of opioids and to increase the use of non-opioid therapy for chronic pain.