Prescription Opioid Use among Patients with Chronic Noncancer Pain before and after the COVID-19 Outbreak in Taiwan: A Multicenter Prospective Observational Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Study Instrument
2.3. Follow-Up Survey on Opioid Prescriptions
2.4. Statistical Analysis
3. Results
4. Discussion
4.1. Major Findings
4.2. Impact of COVID-19 Outbreak and Opioid Overdose
4.3. Opioid Tapering or Discontinuation and Suicide Attempts
4.4. Overall Lower Quality of Life
4.5. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Decreased MMEs (Greater than 2.5%) | Equal MMEs (±2.5%) | Increased MMEs (Greater than 2.5%) | p Value | |
---|---|---|---|---|
n (%) | 31 (30.1%) | 27 (26.2%) | 45 (43.7%) | |
Male, n = 63 | 17 (54.8%) | 19 (70.4%) | 27 (60.0%) | 0.470 a |
Female, n = 40 | 14 (45.2%) | 8 (29.6%) | 18 (40.0%) | |
Age, year | 54.7 ± 11.9 (33 to 92) | 53.0 ± 11.0 (39 to 89) | 53.0 ± 14.3 (30 to 94) | 0.824 b |
Height, cm | 164.4 ± 9.7 (146 to 185) | 164.2 ± 5.9 (152 to 176) | 162.2 ± 15.3 (100 to 185) | 0.992 c |
Weight, kg | 64.7 ± 14.5 (40 to 97) | 62.0 ± 13.6 (41 to 99) | 61.1 ± 17.1 (30 to 100) | 0.593 b |
BMI, kg/m2 | 23.9 ± 4.7 (15.4 to 34.4) | 23.0 ± 4.9 (14.5 to 34.3) | 23.1 ± 5.0 (15.6 to 33.1) | 0.726 b |
Follow up duration, days | 531.3 ± 56.5 (365 to 619) | 535.8 ± 55.8 (454 to 637) | 528.8 ± 60.8 (357 to 634) | 0.881 b |
Pain duration, months | 148.7 ± 99.7 (14 to 485), 120 | 117.7 ± 87.8 (12 to 300), 89 | 190.8 ± 111.4 (24 to 480), 192 | 0.013 b,* |
Opioid therapy duration, months | 108.8 ± 82.4 (4 to 300), 87 | 107.3 ± 88.4(6 to 300), 78 | 125.4 ± 100.1 (6 to 420), 120 | 0.640 b |
<12 months, n = 6 (5.8%) | 2 (6.5%) | 1 (3.7%) | 3 (6.7%) | 0.893 d |
12 to <36 months, n = 14 (13.6%) | 3 (9.7%) | 5 (18.5%) | 6 (13.3%) | |
≥36 months, n = 83 (80.6%) | 26 (83.9%) | 21 (77.8%) | 36 (80.0%) | |
Pain severity in the past week | ||||
Worst, 0–10 | 8.2 ± 2.0 (3 to 10) | 8.4 ± 1.4 (6 to 10) | 9.0 ± 1.5 (3 to 10) | 0.074 b |
Least, 0–10 | 4.9 ± 2.7 (0 to 10) | 4.3 ± 1.9 (1 to 10) | 5.0 ± 2.8 (0 to 10) | 0.505 b |
Average, 0–10 | 6.4 ± 2.4 (2 to 10) | 5.8 ± 2.1 (3 to 10) | 6.8 ± 2.3 (2 to 10) | 0.186 b |
Pain reduction after medication, % | 48.1 ± 21.7 (10 to 100) | 49.3 ± 14.7 (10 to 80) | 45.8 ± 21.7 (0 to 90) | 0.700 c |
Daily function pain interference in the past week, in average, 0–10 | 4.3 ± 2.9 (0 to 9.6) | 4.2 ± 2.4 (0 to 9.6) | 5.4 ± 2.4 (0 to 10) | 0.114 b |
Marital status | ||||
Married couple, n = 47 (45.6%) | 19 (61.3%) | 15 (55.6%) | 13 (28.9%) | 0.010 a,# |
Single/divorced/widowed, n = 56 (54.4%) | 12 (38.7%) | 12 (44.4%) | 32 (71.1%) | |
Work status before pandemic | ||||
Employed, n = 20 (19.4%) | 7 (22.6%) | 5 (18.5%) | 8 (17.8%) | 0.727 d |
Housekeeping, n = 16 (15.5%) | 5 (16.1) | 4 (14.8%) | 7 (15.6%) | |
Retired, n = 23 (22.3%) | 9 (29.0%) | 7 (25.9%) | 7 (15.6%) | |
Unemployed, n = 44 (42.7%) | 10 (32.2%) | 11 (40.7%) | 23 (51.1%) | |
Jobless due to pain, n = 81 (78.6%) | 25 (80.6%) | 21 (77.8%) | 35 (77.8%) | 0.948 a |
Decreased MMEs (Greater than 2.5%) | Equal MMEs (±2.5%) | Increased MMEs (Greater than 2.5%) | p-Value | |
---|---|---|---|---|
n (%) | 31 (30.1%) | 27 (26.2%) | 45 (43.7%) | |
MMEs, mg/day | ||||
Before pandemic, n = 103 | 231.1 ± 173.4 | 202.6 ± 153.4 | 203.4 ± 232.2 | 0.804 a |
206.5 ± 191.1 (8.0 to 1350.0), 150.0 | (22.9 to 705.0), 225.0 | (34.0 to 608.4), 150.0 | (8.0 to 1350.0), 120.0 | |
During pandemic, n = 103 | 127. 1 ± 136.9 | 202.9 ± 153.9 | 284.9 ± 291.2 | 0.001 b |
215.9 ± 229.5 (0.0 to 1470.0), 140.0 | (0.0 to 660.0), 81.3 | (34.0 to 612.6), 150.0 | (28.8 to 1470.0), 182.8 | |
Difference | −104.1 ± 120.2 | 0.3 ± 1.1 | 81.5 ± 109.1 | <0.001 b |
(−600.0 to −1.7), −60.0 | (−1.3 to 4.2), 0.0 | (8.8 to 595.8), 55.7 | ||
Ratio of difference, % | −44.0 ± 28.9 | 0.1 ± 0.3 | 84.2 ± 135.6 | <0.001 b |
(−100.0 to −5.0), −46.7 | (−0.5 to 1.3), 0.0 | (3.0 to 800.0), 40.0 | ||
Opioids < 12 months, n = 6 (5.8%) | 107.5 ± 31.8 | 60.0 | 43.5 ± 43.8 | 0.377 b |
Opioids 12 to < 36 months, n = 14 (13.6%) | 137.8 ± 156.5 | 190.6 ± 133.0 | 204.3 ± 202.0 | 0.501 b |
Opioids ≥ 36 months, n = 83 (80.6%) | 251.4 ± 177.1 | 212.3 ± 160.9 | 216.6 ± 243.9 | 0.406 b |
MMEs, mg/day/kg body weight | ||||
Before pandemic | 3.6 ± 2.7 | 3.4 ± 2.4 | 3.6 ± 4.3 | 0.942 a |
During pandemic | 2.1 ± 2.3 | 3.4 ± 2.5 | 4.9 ± 4.8 | <0.001 b |
MMEs ≥ 200 mg/day | ||||
Before pandemic, n = 43 (41.7%) | 17 (54.8%) | 11 (40.7%) | 15 (33.3%) | 0.173 c |
During pandemic, n = 38 (36.9%) | 6 (19.4%) | 11 (40.7%) | 21 (46.7%) | 0.047 c |
MMEs ≥ 100 mg/day | ||||
Before pandemic, n = 64 (62.1%) | 22 (71.0%) | 18 (66.7%) | 24 (53.3%) | 0.253 c |
During pandemic, n = 70 (68.0%) | 14 (45.2%) | 18 (66.7%) | 38 (84.4%) | 0.001 c |
MMEs ≥ 90 mg/day | ||||
Before pandemic, n = 69 (67.0%) | 22 (71.0%) | 19 (70.4%) | 28 (62.2%) | 0.662 c |
During pandemic, n = 73 (70.9%) | 14 (45.2%) | 19 (70.4%) | 40 (88.9%) | <0.001 c |
Strong opioids during pandemic, n = 103 | ||||
Oral morphine, n = 57 (55.3%) | 15 (48.4%) | 14 (51.9%) | 28 (62.2%) | 0.449 c |
MMEs of oral morphine, mg/day | 155.5 ± 100.8 | 211.5 ± 171.1 | 252.6 ± 229.9 | 0.286 a |
Fentanyl patch, n = 19 (18.4%) | 1 (3.2%) | 8 (29.6%) | 10 (22.2%) | 0.013 d |
MMEs of fentanyl patch, mg/day | 28.8 | 202.2 ± 101.6 | 278.9 ± 222.9 | - |
Oxycodone, n = 30 (29.1%) | 8 (25.8%) | 6 (22.2%) | 16 (35.6%) | 0.430 c |
MMEs of oxycodone, mg/day | 136.8 ± 213.7 | 63.7 ± 44.5 | 130.0 ± 143.8 | 0.623 a |
Concomitant adjuvants during pandemic | ||||
Gabapentinoids, n = 39 (37.9%) | 10 (32.3%) | 10 (37.0%) | 19 (42.2%) | 0.675 c |
NSAID, n = 8 (7.8%) | 3 (9.7%) | 2 (7.4%) | 3 (6.7%) | 0.898 d |
Antidepressants, n = 20 (19.4%) | 6 (19.4%) | 4 (14.8%) | 10 (22.2%) | 0.744 c |
SSRIs, n = 11 (10.7%) | 1 (3.2%) | 3 (11.1%) | 7 (15.6%) | 0.231 d |
Tricyclic antidepressant, n = 10 (9.7%) | 5 (16.1%) | 1 (3.7%) | 4 (8.9%) | 0.331 d |
Benzodiazepine before, n = 33 (32.0%) | 9 (29.0%) | 9 (33.3%) | 15 (33.3%) | 0.912 c |
Decreased MMEs (Greater than 2.5%) | Equal MMEs (±2.5%) | Increased MMEs (Greater than 2.5%) | p-Value | |
---|---|---|---|---|
n (%) | 31 (30.1%) | 27 (26.2%) | 45 (43.7%) | |
WHO Quality of Life score | ||||
Global Quality of Life, 1–5 | 2.42 ± 0.96 | 2.78 ± 0.75 | 2.18 ± 0.86 | 0.020 a |
Global Health, 1–5 | 2.06 ± 0.93 | 2.30 ± 0.91 | 1.89 ± 0.71 | 0.139 a |
Domain 1: Physical, 4–20 | 9.37 ± 3.19 | 10.01 ± 2.64 | 9.02 ± 3.22 | 0.412 a |
Domain 2: Psychological, 4–20 | 10.22 ± 3.49 | 10.62 ± 2.21 | 9.87 ± 3.53 | 0.607 b |
Domain 3: Social, 4–20 | 11.65 ± 3.21 | 12.00 ± 2.51 | 9.74 ± 3.26 | 0.004 a |
Domain 4: Environmental, 4–20 | 11.50 ± 2.83 | 11.93 ± 2.76 | 11.23 ± 3.03 | 0.619 a |
Total score of 4 domains, 16–80 | 42.75 ± 11.49 | 44.56 ± 8.67 | 39.86 ± 11.68 | 0.193 a |
Constipation, n = 62 (60.2%) | 20 (64.5%) | 19 (70.4%) | 23 (51.1%) | 0.228 c |
Laxative before pandemic, n = 28 (27.2%) | 7 (22.6%) | 8 (29.6%) | 13 (28.9%) | 0.787 c |
Laxative during pandemic, n = 35 (34.0%) | 8 (25.8%) | 9 (33.3%) | 18 (40.0%) | 0.437 c |
Depression diagnosis, n = 50 (48.5%) | 13 (41.9%) | 18 (66.7%) | 19 (42.2%) | 0.090 c |
Suicidal ideation | ||||
Always or frequently, n = 14 (13.6%) | 7 (22.6%) | 1 (3.7%) | 6 (13.3%) | 0.303 d |
Sometimes, n = 26 (25.2%) | 6 (19.4%) | 7 (25.9%) | 13 (28.9%) | |
Seldom or never, n = 63 (61.2%) | 18 (58.1%) | 19 (70.4%) | 26 (57.8%) | |
Beck Depression Inventory score, 0–63 | 20.9 ± 15.8 | 18.2 ± 12.3 | 24.3 ± 15.8 | 0.244 a |
0–18 (minimal or mild), n = 50 | 15 (48.4%) | 16 (59.6%) | 19 (42.2%) | 0.375 c |
19–63 (moderate or severe), n = 53 | 16 (51.6%) | 11 (40.7%) | 26 (57.8%) |
Decreased MMEs (Greater than 2.5%) | Equal MMEs (±2.5%) | Increased MMEs (Greater than 2.5%) | p-Value | |
---|---|---|---|---|
n (%) | 31 (30.1%) | 27 (26.2%) | 45 (43.7%) | |
Afraid of opioid addiction | ||||
Strongly agree or agree, n = 33 (32.0%) | 7 (22.6%) | 8 (29.6%) | 18 (40.0%) | 0.161 a |
Uncertain, n = 12 (11.7%) | 2 (7.4%) | 6 (22.3%) | 4 (8.9%) | |
Strongly disagree or disagree, n = 58 (56.3%) | 22 (71.0%) | 13 (48.1%) | 23 (51.1%) | |
Willing to stop opioids | ||||
Strongly agree or agree, n = 26 (25.2%) | 6 (19.4%) | 8 (29.6%) | 12 (26.7%) | 0.886 a |
Uncertain, n = 16 (15.5%) | 6 (19.3%) | 4 (14.8%) | 6 (13.3%) | |
Strongly disagree or disagree, n = 61 (59.2%) | 19 (61.3%) | 15 (55.6%) | 27 (60.0%) | |
Taking more pain medication than prescribed | ||||
Always or frequently, n= 5 (4.9%) | 2 (6.5%) | 2 (7.4%) | 1 (2.2%) | 0.413 a |
Sometimes, n = 12 (11.7%) | 5 (16.1%) | 1 (3.7%) | 6 (13.4%) | |
Seldom or never, n = 86 (83.5%) | 24 (77.4%) | 24 (88.9%) | 38 (84.4%) | |
Borrowing pain medication from someone else | ||||
Always or frequently, n = 0 (0.0%) | 0 | 0 | 0 | 1.000 a |
Sometimes, n = 2 (1.9%) | 1 (3.2%) | 0 | 1 (2.2%) | |
Seldom or never, n = 101 (98.1%) | 30 (96.8%) | 27 (100.0%) | 44 (97.8%) | |
Visiting the emergency room for more pain medication | ||||
Always or frequently, n = 5 (4.9%) | 2 (6.5%) | 1 (3.7%) | 2 (4.4%) | 0.008 a,* |
Sometimes, n = 20 (19.4%) | 7 (22.5%) | 0 | 13 (28.9%) | |
Seldom or never, n = 78 (75.7%) | 22 (71.0%) | 26 (96.3%) | 30 (66.7%) |
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Chen, J.-L.; Ho, S.-T.; Sun, W.-Z.; Tsai, Y.-C.; Cheng, K.-I.; Liu, Y.-C.; Hsieh, Y.-J.; Wen, Y.-R.; Wang, P.-K.; Sung, C.-S.; et al. Prescription Opioid Use among Patients with Chronic Noncancer Pain before and after the COVID-19 Outbreak in Taiwan: A Multicenter Prospective Observational Study. Healthcare 2022, 10, 2460. https://doi.org/10.3390/healthcare10122460
Chen J-L, Ho S-T, Sun W-Z, Tsai Y-C, Cheng K-I, Liu Y-C, Hsieh Y-J, Wen Y-R, Wang P-K, Sung C-S, et al. Prescription Opioid Use among Patients with Chronic Noncancer Pain before and after the COVID-19 Outbreak in Taiwan: A Multicenter Prospective Observational Study. Healthcare. 2022; 10(12):2460. https://doi.org/10.3390/healthcare10122460
Chicago/Turabian StyleChen, Jia-Lin, Shung-Tai Ho, Wei-Zen Sun, Yu-Chuan Tsai, Kuang-I Cheng, Yen-Chin Liu, Yi-Jer Hsieh, Yeong-Ray Wen, Po-Kai Wang, Chun-Sung Sung, and et al. 2022. "Prescription Opioid Use among Patients with Chronic Noncancer Pain before and after the COVID-19 Outbreak in Taiwan: A Multicenter Prospective Observational Study" Healthcare 10, no. 12: 2460. https://doi.org/10.3390/healthcare10122460