Denial of prescription pain medication among people who use drugs in Vancouver, Canada
Abstract Background People who use drugs experience pain at two to three times the rate of the general population and yet continue to face substantial barriers to accessing appropriate and adequate treatment for pain. In light of the overdose crisis and revised opioid prescribing guidelines, we soug...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | Harm Reduction Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12954-024-00956-5 |
| _version_ | 1797233693885988864 |
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| author | Evelyne Marie Piret M.-J. Milloy Pauline Voon JinCheol Choi Kora DeBeck Kanna Hayashi Thomas Kerr |
| author_facet | Evelyne Marie Piret M.-J. Milloy Pauline Voon JinCheol Choi Kora DeBeck Kanna Hayashi Thomas Kerr |
| author_sort | Evelyne Marie Piret |
| collection | DOAJ |
| description | Abstract Background People who use drugs experience pain at two to three times the rate of the general population and yet continue to face substantial barriers to accessing appropriate and adequate treatment for pain. In light of the overdose crisis and revised opioid prescribing guidelines, we sought to identify factors associated with being denied pain medication and longitudinally investigate denial rates among people who use drugs. Methods We used multivariable generalized estimating equations analyses to investigate factors associated with being denied pain medication among people who use drugs reporting pain in three prospective cohort studies in Vancouver, Canada. Analyses were restricted to study periods in which participants requested a prescription for pain from a healthcare provider. Descriptive statistics detail denial rates and actions taken by participants after being denied. Results Among 1168 participants who requested a prescription for pain between December 2012 and March 2020, the median age was 47 years and 63.0% were male. Among 4,179 six-month observation periods, 907 (21.7%) included a report of being denied requested pain medication. In multivariable analyses, age was negatively associated with prescription denial (adjusted odds ratio [AOR] = 0.98, 95% confidence interval [CI]:0.97–0.99), while self-managing pain (AOR = 2.48, 95%CI:2.04–3.00), experiencing a non-fatal overdose (AOR = 1.51, 95%CI:1.22–1.88), engagement in opioid agonist therapy (AOR = 1.32, 95%CI:1.09–1.61), and daily use of heroin or other unregulated opioids (AOR = 1.32, 95%CI:1.05–1.66) were positively associated with being denied. Common actions taken (n = 895) after denial were accessing the unregulated drug supply (53.5%), doing nothing (30.6%), and going to a different doctor/emergency room (6.1%). The period following the introduction of new prescribing guidelines was not associated with a change in denial rates. Conclusions A substantial proportion of people who use drugs continue to be denied prescriptions for pain, with such denial associated with important substance use-related harms, including non-fatal overdose. Guidelines specific to the pharmaceutical management of pain among people who use drugs are needed. |
| first_indexed | 2024-04-24T16:20:14Z |
| format | Article |
| id | doaj.art-b925953d45544827a2d79140422207a3 |
| institution | Directory Open Access Journal |
| issn | 1477-7517 |
| language | English |
| last_indexed | 2024-04-24T16:20:14Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Harm Reduction Journal |
| spelling | doaj.art-b925953d45544827a2d79140422207a32024-03-31T11:14:21ZengBMCHarm Reduction Journal1477-75172024-03-0121111310.1186/s12954-024-00956-5Denial of prescription pain medication among people who use drugs in Vancouver, CanadaEvelyne Marie Piret0M.-J. Milloy1Pauline Voon2JinCheol Choi3Kora DeBeck4Kanna Hayashi5Thomas Kerr6British Columbia Centre On Substance UseBritish Columbia Centre On Substance UseBritish Columbia Centre On Substance UseBritish Columbia Centre On Substance UseBritish Columbia Centre On Substance UseBritish Columbia Centre On Substance UseBritish Columbia Centre On Substance UseAbstract Background People who use drugs experience pain at two to three times the rate of the general population and yet continue to face substantial barriers to accessing appropriate and adequate treatment for pain. In light of the overdose crisis and revised opioid prescribing guidelines, we sought to identify factors associated with being denied pain medication and longitudinally investigate denial rates among people who use drugs. Methods We used multivariable generalized estimating equations analyses to investigate factors associated with being denied pain medication among people who use drugs reporting pain in three prospective cohort studies in Vancouver, Canada. Analyses were restricted to study periods in which participants requested a prescription for pain from a healthcare provider. Descriptive statistics detail denial rates and actions taken by participants after being denied. Results Among 1168 participants who requested a prescription for pain between December 2012 and March 2020, the median age was 47 years and 63.0% were male. Among 4,179 six-month observation periods, 907 (21.7%) included a report of being denied requested pain medication. In multivariable analyses, age was negatively associated with prescription denial (adjusted odds ratio [AOR] = 0.98, 95% confidence interval [CI]:0.97–0.99), while self-managing pain (AOR = 2.48, 95%CI:2.04–3.00), experiencing a non-fatal overdose (AOR = 1.51, 95%CI:1.22–1.88), engagement in opioid agonist therapy (AOR = 1.32, 95%CI:1.09–1.61), and daily use of heroin or other unregulated opioids (AOR = 1.32, 95%CI:1.05–1.66) were positively associated with being denied. Common actions taken (n = 895) after denial were accessing the unregulated drug supply (53.5%), doing nothing (30.6%), and going to a different doctor/emergency room (6.1%). The period following the introduction of new prescribing guidelines was not associated with a change in denial rates. Conclusions A substantial proportion of people who use drugs continue to be denied prescriptions for pain, with such denial associated with important substance use-related harms, including non-fatal overdose. Guidelines specific to the pharmaceutical management of pain among people who use drugs are needed.https://doi.org/10.1186/s12954-024-00956-5PainPain managementPrescription denialPeople who use drugsPrescribing guidelines |
| spellingShingle | Evelyne Marie Piret M.-J. Milloy Pauline Voon JinCheol Choi Kora DeBeck Kanna Hayashi Thomas Kerr Denial of prescription pain medication among people who use drugs in Vancouver, Canada Harm Reduction Journal Pain Pain management Prescription denial People who use drugs Prescribing guidelines |
| title | Denial of prescription pain medication among people who use drugs in Vancouver, Canada |
| title_full | Denial of prescription pain medication among people who use drugs in Vancouver, Canada |
| title_fullStr | Denial of prescription pain medication among people who use drugs in Vancouver, Canada |
| title_full_unstemmed | Denial of prescription pain medication among people who use drugs in Vancouver, Canada |
| title_short | Denial of prescription pain medication among people who use drugs in Vancouver, Canada |
| title_sort | denial of prescription pain medication among people who use drugs in vancouver canada |
| topic | Pain Pain management Prescription denial People who use drugs Prescribing guidelines |
| url | https://doi.org/10.1186/s12954-024-00956-5 |
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