[Opioid use disorders during long-term opioid treatment : Risk factors and action approaches in patients with chronic nontumor pain from an outpatient medical perspective].

Abstract

Background: Long-term opioid use (> 3 months) can be an important element in the treatment of patients with chronic nontumor pain but it is also discussed in association with risks for the development of opioid use disorder. This analysis aims to explore the risk factors for opioid use disorder in long-term opioid treatment, barriers for its identification and starting points for different solutions to overcome these barriers from a medical perspective.

Methods: A cross-sectional postal survey was sent in Autumn 2021 to 1854 physicians involved in outpatient treatment in Germany. A random sample of 1300 physicians were drawn from the pool of an address service and all members of the Professional Association of Physicians and Psychological Psychotherapists in Pain and Palliative Medicine in Germany (BVSD, n = 554) were contacted. A reminder was sent out in January 2022.

Results: A total of 422 physicians participated in the survey, one third were primary care physicians (33%) and 65% had received additional training "specialist pain therapy". On a scale from 1 = full approval to 5 = full rejection, treatment of chronic pain by different physicians was perceived as the most important risk factor for opioid use disorder (mean (MW): 1.33, standard deviation (SD): 0.596). Further important risk factors were treatment specific. Intentional disguise by the patient (MW 1.73/SD 0.888) and opioid prescriptions by different physicians (MW 1.79/SD 0.635) were perceived as major hurdles for the identification of opioid use disorder. Regular prescription controls (MW 1.37/SD 0.648) and periodical patient contact (MW 1.49/SD 0.654) were perceived as the most important approach to reveal opioid use disorders.

Discussion: The present study gives a quantification of structural and treatment-specific risk factors in the German context. This could serve as an important foundation for the development of a health policy approach to tackle these hurdles. The results indicate that fostering transparency and communication are important aspects.