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UBC study finds link between medically prescribed opioids and injection drug use

Patients on chronic prescription opioid therapy for non-cancer pain about eight times more likely to start injection drug use, new study from UBC and BC Center medical researchers finds for Disease Control (BCCDC).

the to study, recently published in The BMJ, demonstrates one of the potential risks associated with prescription opioid therapy, which is not generally recommended as a first-line treatment for chronic pain.

“At a time when we are experiencing a catastrophic epidemic of overdose linked to a supply of toxic illicit drugs, it is deeply concerning the increased rate at which these patients are switching to injection drug use,” said the author. Principal, Dr. Roy Purssell, Acting. Co-Director and Professor in the Department of Emergency Medicine at UBC and Medical Director of the BC Drug and Poison Information Center at BCCDC. “This is a wake-up call for healthcare providers, who must be increasingly judicious in the management of these drugs and in the support of the people who use them.

Dr Roy Purssell

While previous research has primarily focused on people who obtain prescription opioids through non-medical means, such as friends, family, or drug traffickers, this is one of the first studies to examine injection drug use in patients who have been medically prescribed opioids.

The research team analyzed prescription information from nearly 1.7 million people in British Columbia using the Integrated Data and Evaluative Analytics (IDEAs) database, also known as the BC Hepatitis Testers Cohort. . Using this large dataset, the researchers identified patients who received prescription opioid therapy and classified the treatment as chronic (frequent use for more than 90 days), episodic (infrequent use for more than 90 days). 90 days) or acute (less than 90 days). Almost 15,000 people underwent chronic treatment between 2000 and 2015.

The team then looked at which people had started injection drug use based on evidence of an injection drug use problem and injection-related infection.

The analysis found that four percent of people receiving chronic opioid treatment started injecting drugs within five years. This was higher than those with episodic use (1.3%), acute use (0.7%), or no history of prescription opioid use (0.4%). Initiation to injection drug use was also found to be more common with higher prescribed opioid doses and among young people.

“There can be a number of reasons why we see people switch to injection drug use, such as increased tolerance, a need to manage uncontrolled pain, or suddenly stopping treatment,” said Dr. Purssell. “Each patient’s journey is unique, and it really highlights the importance of shared decision-making that puts the needs and well-being of the patient first.

“This is a wake-up call for healthcare providers, who must be increasingly judicious in the management of these drugs and in the support of the people who use them.
Dr Roy Purssell

Previous research has identified poorly managed pain and denial of pain treatment as risk factors for illicit drug use. Recognizing this, the Canadian Pain Task Force called for shared decision making between health care providers and people living with chronic pain that balances the pros and cons of opioid drugs.

The researchers stressed that the results should not be used to support reducing or unintentionally stopping opioid treatment, as this could increase the risk of harm and lead to illicit drug use in some people, potentially increasing the risk. of overdose and death from the illicit toxic substance. drug supply.

Instead, Dr Purssell suggests we need to do more to meet the needs of people with chronic pain.

“We need to improve access to multidisciplinary pain management approaches that include non-opioid interventions, such as behavior therapy. There are also steps we can take to prevent and treat prescription opioid addiction, such as support and resources to help people voluntarily and slowly decrease or stop opioids, which could reduce the risk of onset. injection drug use.

This study was supported by the British Columbia Center for Disease Control and Canadian Institutes of Health Research.