Withdrawal and Misuse Concerns of Consumers regarding Opioid Analgesic and Anxiolytic, Hypnotic and Sedative Medicines

Abstract

Background

Opioid analgesic (OA) and anxiolytic, hypnotic and sedative (AHS) medicines use raise community concerns about risks of dependence: dose escalation, unintentional misuse. Objectives: We aimed to identify common consumer OA and AHS information gaps and concerns that led to information seeking from a hotline. Methods: We conducted a retrospective, mixed-method observational study of consumers’ OA and AHS-related calls to an Australian national medicines call center (September 2002-30 June 2010). We analyzed these medicines’ call characteristics compared to their respective rest of calls (ROC) and thematically explored narratives concerning withdrawal and misuse. Results: Of 123,217 calls, 7,395 (6.0%) involved OA and 7,789 (6.2%) AHS, with consistency between call characteristics. While female middle-aged callers predominated, more males called for these medicines than their complementary ROC. Uncertainty about unresolved OA and AHS concerns led to help-seeking that was consistent over eight years. Main motivations were inadequate information (OA 44.5%; AHS 41.2%), seeking a second opinion (OA 24.2%; AHS 24.2%), worrying symptoms (OA 21.6%; AHS 23.1%), and conflicting information (OA 4.9%; AHS 5.1%). Callers focused on withdrawal and issues related to inadvertent overuse or deliberate misuse (OA 9.2% vs. non-OA ROC 2.9%; AHS 12.6% vs. non-AHS ROC 2.7%). Primary themes were similar for both cohorts: concern about harm or aiming to minimize harm by information seeking, requesting a strategy, or reassurance. Conclusions: Consumers have under-recognized perceptions of harm from OA and AHS use, particularly withdrawal and misuse. Resources based on real world consumer concerns can encourage open dialogue between patients and their prescribers.

Keywords:

• Anti-anxiety agents
• hypnotics and sedatives
• analgesics
• opioid
• substance-related disorders
• help-seeking behavior
• drug information services
• information seeking behavior

Acknowledgements

We would like to acknowledge NPS MedicineWise (formerly National Prescribing Service, Australia), funder of NPS Medicines Line and service provider since July 2010. We would also like to thank Mater Health, Brisbane for providing the raw service data from September 2002 to 30 June 2010.

Disclosure statement

No potential conflict of interests were reported by the authors.

Funding source

There was no external finding for this study; it was funded from existing salaries.

Data availability statement

Restrictions apply to the public availability of the data that support the study findings. Data are however available from the authors upon reasonable request and with permission of the service funder, NPS MedicineWise (formerly National Prescribing Service, Australia).

Contributions of each coauthor

TM, MVD and SH conceived the study. TM and SH extracted and analyzed the quantitative data. KS and TM analyzed the qualitative data. KS wrote the first draft. All authors contributed to the writing of the manuscript.