Reasons for under-use of prescribed opioid medications by patients in pain.

BACKGROUND: With the growth in opioid therapy for the treatment of chronic pain, health care providers have focused their attention on avoiding over-use of opioid medications, specifically to avoid addiction, dependency, and other misuse. Qualitative and quantitative reviews of medication adherence, in contrast, focus primarily on why patients under-use or do not take their medications as prescribed and find nonadherence rates of approximately 25%.
OBJECTIVE: To identify the prevalence of under-use of opioid medications and the reasons and implications of under-use.
DESIGN: As part of a variety of structured assessments, subjects were asked detailed questions about how they used their opioid medication in their daily lives. PARTICIPANTS: One hundred ninety-one veterans who received an opioid prescription for any pain problem within the 12 months before the interview. MEASURES: We defined a patient who under-used his/her medication as one who took less than their prescribed dose of medication and reported that pain impaired their ability to engage in normal daily activities.
RESULTS: Under-use of opioids (20%) was more common than over-use (9%), consistent with research on medication adherence. Patients who under-used their opioids offered the same reasons for under-use that patients report for other medications. However, while under-users reported more pain than other opioid users they filled only slightly fewer opioid prescriptions. Communication problems between patients and providers about opioids were common.
CONCLUSIONS: Improved communication between patients and providers and shared decision-making regarding opioid prescriptions may improve pain management and minimize the problems associated with over-prescription of opioids (i.e., diversion).