(164) Negative Affect as a Predictor of Opioid Prescription Misuse and Abuse in Chronic Pain Patients: A Collaborative Health Outcomes Information Registry Study

Abstract

The widespread misuse and abuse of prescribed opioid pain relievers amongst chronic pain patients is a central contributor to the opioid epidemic. The current study aimed to identify potential risk factors and treatment targets that may reduce and prevent opioid misuse. The NIH s Patient Reported Outcomes Measurement Information System (PROMIS)-Abuse of Prescription Medication item bank (Rx-Abuse) was validated in both community and clinical samples to assess self-reported severity of medication abuse. The Rx-Abuse item bank was included in Stanford University s Collaborative Health Outcomes Information Registry (CHOIR), an open-source healthcare system to monitor chronic pain patients’ health status as part of clinical care, quality improvement, and research. We compared physical, mental and social health status factors of patients taking and not taking opioid medications and examined which of these factors best associated with prescription abuse. We hypothesized that negative affect would predict more opioid misuse in view of its crucial role in managing chronic pain and substance use. A sample of 1193 (age=50.72±14.97;\xa064.04% female, mean pain=5.24±2.47) patients with a mix of chronic pain disorders presenting for medical evaluations at a tertiary pain clinic completed the CHOIR survey. Participants endorsing current use of prescribed opioid medication (n=692, 58.01%) also completed the Rx-Abuse assessment. Results indicated that patients currently taking opioid medications reported significantly greater symptomatology and impairment across almost all PROMIS and pain severity measures compared to non-opioid taking patients. A data-driven stepwise hierarchical regression analysis (n=589) confirmed that a composite score of negative affect comprising anxiety, anger and depression, was the most significant predictor (β=0.36, p