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National trends in opioid use: Why monitoring is important for pain medication management

According to the International Association for the Study of Pain, chronic pain generally refers to pain that “persists beyond normal tissue healing time, which is assumed to be three months.” 1 The statistics on the prevalence of chronic pain and the pervasive inappropriate use of pain medication make an overwhelming case for pain medication monitoring.

  • One in four Americans suffers from chronic pain.2
  • Chronic noncancer pain (CNCP) is a leading cause of disability.3,4
  • For many patients, opioids are an integral part of a comprehensive pain management plan to help relieve pain, restore functioning and improve quality of life.5
  • Through urine drug testing, one national study found that 75% of pain patients may not be taking their medications as prescribed. The study also found the following about the monitored patients:
    • 39% did not have the prescribed opioid present.
    • 29% had non-prescribed opioid medications present.
    • 27% had a higher than expected amount of the prescribed medication present.
    • 15% had a lower than expected amount of the prescribed medication present.
    • 11% had illicit drugs detected in their urine.6
  • The 2007 National Survey on Drug Use and Health reports a steady increase in the number of Americans abusing prescription pain relievers. 7
  • Rising rates of prescription drug abuse and emergency room admissions related to prescription drug abuse, as well as an increase in the theft and illegal resale of prescription drugs, indicate that drug diversion is a growing problem nationwide.8The main source of drug diversion is unlikely the prescriber as was once assumed, but rather from theft by family, friends and workers in the home or from the sharing and selling of medications though often with good intentions.9

The statistics underscore the importance of making urine drug monitoring integral to chronic pain care.

References

1.International Association for the Study of Chronic Pain. Available at: http://www.iasp-pain.org/AM/Template.cfm?Section=Pain_Definitions&Templat=/CM/HTMLDisplay.cfm&ContentID=1728. Accessed July 22, 2009.

2. American Pain Foundation. Pain Facts: Overview of American Pain Surveys. Available at: http://www.painfoundation.org/learn/library/qa. Updated January 2007. Accessed March 30, 2009.

3. Centers for Disease Control and Prevention: Prevalence of disabilities and associated health conditions among adults; United States, 1999. MMWR 50:120-125, 2001

4. Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R: Lost productive time and cost due to common pain conditions in the workforce. JAMA 290:2443-2454, 2003

5. Fine, PG. Opioid Therapy as a Component of Chronic Pain Management: Pain Experts Weigh In on Key Principles to Optimize Treatment. Topics in Pain Management. May 2008;23(10):1-8.

6. Couto JE, Goldfarb NI, Leider HL, Romney MC, Sharma S. High rates of inappropriate drug use in the chronic pain population. Popul Health Manag. 2009;12(4):185–190.

7. Office of Applied Studies. Results from the 2007 National Survey on Drug Use and Health: National Findings. Rockville, MD: Substance Abuse and Mental Health Administration; 2008.

8. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Drug Abuse Warning Network, 2005: National Estimates of Drug-Related Emergency Department Visits. DAWN Series D-29, DHHS Publication No. (SMA) 07-4256, Rockville, MD, 2007. Available at http://dawninfo.samhsa.gov/files/DAWN-ED-2005-Web.pdf.

9. Substance Abuse and Mental Health Services Administration. (2008). Results from the 2007 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-34).