Socioeconomic risk factors for long‐term opioid use: A national registry‐linkage study

Abstract

AbstractBackgroundOpioid use has increased substantially as a treatment for chronic pain, although harms from long‐term opioid therapy outweigh the benefits. More knowledge about factors associated with long‐term opioid use is needed. We aimed to investigate the association between socioeconomic status and long‐term opioid use in the period 2010–2019.MethodsThis was a nested case–control study in which the cases were all persons ≥18 years with long‐term opioid use, that is use of opioids for more than 3 months (N = 215,642). Cases were matched on gender, age and index year (first long‐term use period) with four controls who filled at least one opioid prescription, but never developed long‐term opioid use in the study period (N = 862,568). We performed a logistic regression analysis adjusted for relevant confounders, stratified on age groups (18–67 years and 68 years and above).ResultsIn the younger age group, long‐term opioid use was associated with low education (adjusted odds ratio, aOR = 1.54; 95% confidence interval, CI [1.51–1.57]), low income (1.33 [1.31–1.36]), being unemployed (1.40 [1.38–1.42]) and receiving disability pension (1.36 [1.33–1.38]). Weaker associations were found for living in a single‐person household or in a dense geographical area. Similar associations were found for the older age group.ConclusionWe found that low socioeconomic status was associated with long‐term opioid use both among people in working age and older people. These results indicate a need for social and financial support for non‐pharmacological treatment of chronic pain among people with lower socioeconomic status.SignificanceThis study shows that people with low socioeconomic status are at higher risk of developing long‐term opioid use. In the clinical setting, physicians should consider socioeconomic status when prescribing opioids for chronic pain. Non‐pharmacological treatment options funded by public health services should be prioritized to those with low socioeconomic status as long‐term opioid use in chronic pain patients is not recommended.