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Study Shows Men and Women Have Different Risk Factors for Abuse of Prescription Painkillers
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Reviewed By Laura J. Martin, MD
Predictors of such abuse are different in men and women, researchers say, and knowing this could help doctors adopt treatment plans that are less likely to cause misuse of opioid medications.
The finding comes from a study involving 662 chronic noncancer patients taking opioid drugs for pain relief.
Researchers say misuse by women seems to be closely related to psychological distress. Prescription pain drugs are more likely to be misused by men who have social and behavioral problems.
"Since little has been published about gender differences and misuse of prescription pain medication, it is valuable to document whether risk factors for abuse are gender specific to some degree," says study researcher Robert N. Jamison, PhD, a clinical psychologist at Harvard's Brigham and Women's Hospital.
The study shows that men and women have similar frequencies of aberrant drug behavior but different risk factors for abuse of opioids.
Women who misuse pain drugs are more likely "to admit to being sexually or physically abused or have a history of psychiatric or psychological problems," Jamison says.
Women who are being treated for pain not caused by cancer and who exhibit signs of significant stress should be treated for mood disorders and counseled on dangers of relying on pain pills to help them sleep or reduce stress, the researchers say.
Men taking pain pills should be closely monitored for suspected behavioral problems, Jamison says. In addition, their pills should be counted to check adherence, and frequent urine screens also should be done.
Abuse of Opioids Is Growing
Jamison and colleagues write in the study that the use of opioids for chronic pain has been growing, and that between 3% and 16% of the population has a substance use disorder.
Indeed, some pain centers that dispense opioids "are overwhelmed with patients who are known or suspected to be abusing" their medications, the researchers write.
The study involved patients who had been prescribed opioids for chronic noncancer pain; about half the participants were men, half were women.
Five months into the study they were interviewed and had to submit a urine sample. Physicians also completed a substance misuse behavior checklist.
The researchers write that women in the study tended to display signs of emotional issues and affective distress, compared with men.
Men tended to show signs of worrisome behaviors, such as association with other people who abused drugs and alcohol and engaging in criminal behavior.
For women, a history of sexual abuse was an issue in later misuse of prescription drugs. "These results are in agreement with past research that highlighted the importance of sexual and physical abuse history in predicting opioid misuse," the researchers write. "These same studies also showed that women with a significant history of anxiety and depression tend to do less well in properly managing opioids prescribed for pain, possibly because of the tendency to self-medicate a mood disorder using opioids."
The researchers also say that past research has suggested that women may be more open and truthful about behaviors and to seek psychological help than men.
"Given the prominence of sex differences in a variety of pain-related processes, we may eventually arrive at a method for tailoring risk assessment and risk-reducing interventions in part as a function of gender," the researchers say, adding that more research is called for by their study.
The study is published in the April issue of The Journal of Pain.
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Jamison, R. The Journal of Pain, April 2010; vol 11: pp 312-320.
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