Patients on Chronic Opioids Likely to Live in Disadvantaged Neighborhoods, Have Worse Anxiety and Depression

Newswise — People treated with chronic opioid therapy for pain are more likely to live in socially disadvantaged areas and self-report worse anxiety, depression and pain that interferes in their lives, according to a new study presented this week at the Association of Academic Physiatrists Annual Meeting.

Opioids have been linked to likelihood of addiction and other negative outcomes. In the past, opioids were recommended as a first-line pain therapy. However, patients in racially and economically marginalized groups were prescribed less opioid medication than their white, wealthier counterparts. Once opioids’ dangers became widely recognized, national pain management guidelines changed to recommend non-opioid alternatives, but these treatments are often more expensive. Researchers set out to find out if socially disadvantaged patients are now more likely to be prescribed an opioid, and to learn more about their experiences.

“Since the devastation of the opioid epidemic first received national attention, patients and physicians have been more and more interested in switching to non-opioid alternatives for pain management,” said Abby L. Cheng, MD, Co-Director, Physiatry Resident Musculoskeletal Research, at Washington University in St. Louis School of Medicine. “In our clinic, we noticed that some patients who want to wean off opioids do not have access to other types of treatment, like physical therapy, injections or pain psychology counseling. Many of these patients have insufficient insurance coverage, and others live in communities with less access to pain management resources. We wondered if these patients were continuing to routinely use opioid medication because they and their doctors felt it was the only pain management treatment that was realistically available for them.”

Researchers conducted a cross-sectional analysis of retrospective medical record data from one academic medical center from 2000 to 2019. Adult patients followed for chronic musculoskeletal pain were split into two groups: chronic adherent opioid therapy vs. no chronic opioid therapy.

The study compared the difference in social disadvantage in patients who were and were not managed with chronic opioid therapy. Disadvantage was defined by residential zip codes within the worst national quartile of the Area Deprivation Index. Researchers also compared differences in self-reported health based on opioid use measured by the Patient-Reported Outcomes Measurement Information System (PROMIS), after they controlled for age, sex, race, and social disadvantage.

The study included 1,173 patients, of whom 365 were on chronic opioids. Compared to patients not routinely taking these drugs, people on chronic opioids were more likely to live in a zip code within the most socially disadvantaged national quartile. Chronic opioid therapy was also linked to worse self-reported depression, anxiety and pain interference symptoms.

“We hope our study findings support advocacy efforts to improve accessibility of non-opioid pain management options for socioeconomically disadvantaged patients,” said Dr. Cheng. “We support improved insurance coverage of multidisciplinary, research-based pain management treatments that are proven to help reduce pain and improve function without the use of opioid medication.”

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The Association of Academic Physiatrists (AAP) is a professional society with a mission to create the future of academic physiatry through mentorship, leadership, and discovery. Its members are leading physicians, researchers, educators and in-training physiatrists from over 40 countries. The AAP holds an Annual Meeting, produces a leading medical journal in rehabilitation: AJPM&R, and leads a variety of programs and activities that support and enhance academic physiatry. On February 9-13, 2021, the AAP is hosting its first-ever virtual Annual Meeting, Physiatry ‘21. To learn more about the association, the specialty of physiatry and Physiatry ‘21, visit physiatry.org and follow us on Twitter at @AAPhysiatrists.