Social Determinants of Health among Individuals Receiving Opioids for Pain Management.

Abstract

Objective: Individuals receiving opioids for pain management are at risk for negative outcomes. However, it is not clear whether social determinants of health (SDOH) predict outcomes a year after starting a prescription opioid. The purpose was to examine associations between SDOH with psychiatric-, pain-, and opioid-related outcomes at a 12-month follow-up.

Methods: Participants (N=783) with a new period of 30-90-day opioid use completed baseline and 12-month follow-up questionnaires regarding SDOH, depressive symptoms, pain severity, pain interference, and opioid use. Multivariate adjusted models estimated the association between SDOH and outcomes.

Results: Participants had a mean age of 53.4 years (SD=11.9), 71.2% White race, and 69.9% women. Older age (OR=0.97; 0.95, 0.99) and Black race (OR=0.45; 0.27, 0.76) were inversely associated with depression, while being widowed/divorced/separated (OR=1.72; 1.01, 2.91) and lacking college education (OR=2.43; 1.25, 4.73) were positively associated with depression. Women (OR=1.56; 1.12, 2.18) and lower income (OR=2.09; 1.14, 3.85) were associated with greater odds of opioid use, while unemployment was associated with lower odds of opioid use at 12 months (OR=0.55; 0.34, 0.89). Older age (OR=0.95; 0.91, 0.99) was inversely associated with opioid use concerns while disability (OR=4.59; 1.60, 13.11) was positively associated.

Discussion: Several SDOH variables were associated with poorer functioning at baseline and 12-months after individuals were prescribed an opioid. It may be useful for clinicians to screen for SDOH to identify higher-risk individuals.