Prevalence of prescription drug abuse among patients with chronic pain attending in a pain clinic of a tertiary hospital

Abstract

Background: Chronic pain and prescription drug abuse are extremely prevalent worldwide. Non-medical use of prescription drugs like opioids, central nervous system depressants and stimulants can lead to addiction, abuse or misuse, and diversion. It is not known what proportion of patients have already been exposed to prescription drug abuse presenting for chronic pain management. The main objective of the study was to assess the prevalence of prescription drug abuse among the patients presenting for chronic pain management.
Method: The study was conducted at the out patient’s settings in the Pain Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh, Dhaka. Study population included patients suffering from chronic pain of at least 2 years duration and patients over 18 years of age. Both quantitative and qualitative methods of investigation were followed. The quantitative data was collected by face-to-face interview, clinical evaluation and recording of reports. Based on the patient information recorded 30 patients ( one-tenth of quantitative sample) were selected to find out the qualitative details through in-depth investigation of extent, trends, patterns and consequences of prescription drug abuse or misuse characteristics.
Results: Quantitative data was collected from 305 patients. The average age of patients was 39.92 ± 9.61 years and male to female ratio was 2.2:1. Most of the patients were living in rural area 195 (64%). Chronic musculoskeletal pain was more prevalent among chronic pain patients 31% [95% CI: (26-36)]. The mean (±SD) duration of pain was 6.82 ± 3.45 years. Most commonly prescribed medications were NSAID 81% [95% CI: (76-85)], muscle relaxants 50% [95% CI: (45-56)] and opioids 41% [95% CI: (35-46)]. The prevalence of drug abuse was 64% [95% CI: (59-70)]. The specified ways of drug abuse revealed that 49% [95% CI: (42-56)] patients used medication without legal prescriptions, 21% [95% CI: (16-27)] used more than the prescribed dose and 30% [95% CI: (23-36)] used more than the prescribed duration for relieving pain. NSAID was the most common drug taken without legal prescription 72% [95% CI: (63-81)] and used more than the prescribed dose 57% [95% CI: (42-72)]. The most common cause of taking drugs more than prescribed dose and duration were initially relief of pain but gradually higher dose needed 79% [95% CI: (66-91)] and painful condition worsened after stopping medication 76% [95% CI: (65-87)], respectively. The common problems/complications
related to drug abuse were mental disturbance 78 (26%), sleeplessness 69 (23%) and loss of memory 64 (21%).
Conclusion: The prevalence of prescription drug abuse is high among chronic pain patients. Many patients suffer from abuse-related complications, which is a major concern for the healthcare system.