Identification of prescription opioid misuse and abuse behaviors and risk factors in chronic pain patients using the Prescription Opioid Misuse and Abuse Questionnaire (POMAQ)

Abstract

Objectives

To identify patient risk factors associated with prescription opioid misuse and abuse as well as groupings of misuse and abuse behaviors as measured by the Prescription Opioid Misuse and Abuse Questionnaire (POMAQ).

Methods

Adults with chronic pain requiring long-term treatment with opioids completed the POMAQ and other study questionnaires. Latent class analysis (LCA) was used to examine underlying subgroups exhibiting particular risk profiles. Patient demographic and clinical characteristics were examined as covariates and the concordance between the identified latent classes at-risk classifications and the POMAQ clinical scoring algorithm was assessed.

Results

Analysis of data from 809 patients revealed four classes: “chronic pain, low risk” (n = 473, low to no prevalence of POMAQ behaviors), “chronic pain, comorbid condition” (n = 152, high prevalence of anti-anxiety, sleeping pill, and antihistamine use), “at risk” (n = 154, taking more opioids than prescribed and drinking alcohol with opioids more frequently than other groups), and “high risk” (n = 30, highest prevalence of each behavior). The “high risk” group was associated with being younger, less educated, and unemployed compared to other groups. When examining the LCA classes by groups defined by the original POMAQ clinical scoring algorithm, the “high risk” class had the highest proportion of participants identified with abuse behaviors (46.7%), compared to just 4.7% in the “chronic pain, low risk” group.

Conclusions

Findings suggest there are four distinct subgroups of patients defined by chronic opioid misuse and abuse behaviors and support the use of the POMAQ to identify risk factors associated with prescription opioid misuse and abuse.

Keywords:

• POMAQ
• chronic pain
• latent class analysis
• risk factors
• prescription opioid misuse and abuse

Transparency

Declaration of financial/other relationships

KS Coyne is an employee of Evidera, a company that received funding from the OPC to conduct this study. At the time of the study, AI Barsdorf was employed by Pfizer, a member company of the OPC and JY Mazière was an employee of Boerhinger-Ingelheim, a member company of the OPC. RF Pierson is an employee of Janssen, a member company of the OPC. ST Lanza is an employee of Pennsylvania State University with no financial relationships to declare. JT Farrar is an employee of the University of Pennsylvania and received funding from the OPC for time spent as an expert reviewer for this study to support his salary. HJ Gelfand is employed by the US Military with no financial relationships to declare. L Porter is an employee of Health ResearchTx, a company that received funding from the OPC to conduct this study. SH Schnoll is an employee of Pinney Associates, a company that received funding from the OPC for time spent as an expert reviewer for this study. SF Butler received funding from the OPC for time spent as an expert reviewer for this study. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

KSC, AIB, JYM, RFP, SHS, SFB, and JTF were involved in the conception and design of the study, analysis and interpretation of the data, drafting of the manuscript and revising it critically for intellectual content. HJG and LNP were involved with data collection, data interpretation, drafting of the manuscript and revising it critically for intellectual content. STL was involved with statistical analysis, data interpretation, drafting of the manuscript and revising it critically for intellectual content. All authors provided final approval of the version to be published.

Acknowledgements

The authors thank the following Evidera employees: Christine Thompson for conducting the analyses, Elizabeth Bacci PhD for writing assistance, Michael Grossi and Cody Patton, for copy-editing and formatting this manuscript. Research data derived from approved Naval Medical Research Unit-Dayton, Dayton, Ohio and Naval Medical Center, Portsmouth, Virginia IRB, protocol; number NAMRUD.2015.0004. The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government. CAPT Harold Gelfand, MD is a member of the US Military. This work was prepared as part of his official duties. Title 17 U.S.C. 105 provides that "Copyright protection under this title is not available for any work of the United States Government." Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person’s official duties.

Data availability statement

The research data used in this study were derived in part from approved Naval Medical Research Unit-Dayton, Dayton, Ohio and Naval Medical Center, Portsmouth, Virginia IRB, protocol; number NAMRUD.2015.0004 and cannot be made available.

Additional information

Funding

This project was conducted as part of a Food and Drug Administration (FDA)-required post-marketing study for extended-release and long-acting opioid analgesics and was funded by the Opioid Postmarketing Consortium (OPC) consisting of the following companies: Allergan; Assertio Therapeutics, Inc.; BioDelivery Sciences, Inc.; Collegium Pharmaceutical, Inc.; Daiichi Sankyo, Inc.; Egalet Corporation; Endo Pharmaceuticals, Inc.; Hikma Pharmaceuticals USA Inc.; Janssen Pharmaceuticals, Inc.; Mallinckrodt Inc.; Pernix Therapeutics Holdings, Inc.; Pfizer, Inc.; Purdue Pharma, LP.