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Independent and joint contributions of physical disability and chronic pain to incident opioid use disorder and opioid overdose among Medicaid patients

Published online by Cambridge University Press:  17 November 2023

Katherine L. Hoffman ,
Floriana Milazzo ,
Nicholas T. Williams ,
Hillary Samples ,
Mark Olfson ,
Ivan Diaz ,
Lisa Doan ,
Magdalena Cerda ,
Stephen Crystal  and
Kara E. Rudolph Open the ORCID record for Kara E. Rudolph [Opens in a new window]
Katherine L. Hoffman
Affiliation:
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
Floriana Milazzo
Affiliation:
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
Nicholas T. Williams
Affiliation:
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
Hillary Samples
Affiliation:
Rutgers Institute for Health, Rutgers University, New Brunswick, USA
Mark Olfson
Affiliation:
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
Ivan Diaz
Affiliation:
New York University Grossman School of Medicine
Lisa Doan
Affiliation:
New York University Grossman School of Medicine
Magdalena Cerda
Affiliation:
New York University Grossman School of Medicine
Stephen Crystal
Affiliation:
Rutgers Institute for Health, Rutgers University, New Brunswick, USA
Kara E. Rudolph*
Affiliation:
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
*
Corresponding author: Kara E. Rudolph; Email: kr2854@cumc.columbia.edu
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Abstract

Background

Chronic pain has been extensively explored as a risk factor for opioid misuse, resulting in increased focus on opioid prescribing practices for individuals with such conditions. Physical disability sometimes co-occurs with chronic pain but may also represent an independent risk factor for opioid misuse. However, previous research has not disentangled whether disability contributes to risk independent of chronic pain.

Methods

Here, we estimate the independent and joint adjusted associations between having a physical disability and co-occurring chronic pain condition at time of Medicaid enrollment on subsequent 18-month risk of incident opioid use disorder (OUD) and non-fatal, unintentional opioid overdose among non-elderly, adult Medicaid beneficiaries (2016–2019).

Results

We find robust evidence that having a physical disability approximately doubles the risk of incident OUD or opioid overdose, and physical disability co-occurring with chronic pain increases the risks approximately sixfold as compared to having neither chronic pain nor disability. In absolute numbers, those with neither a physical disability nor chronic pain condition have a 1.8% adjusted risk of incident OUD over 18 months of follow-up, those with physical disability alone have an 2.9% incident risk, those with chronic pain alone have a 3.6% incident risk, and those with co-occurring physical disability and chronic pain have a 11.1% incident risk.

Conclusions

These findings suggest that those with a physical disability should receive increased attention from the medical and healthcare communities to reduce their risk of opioid misuse and attendant negative outcomes.

Keywords

causal inferencechronic paindisabilityMedicaidopioid use disorderoverdosephysical disability

Information

Type
Original Article
Information
Psychological Medicine , Volume 54 , Issue 7 , May 2024 , pp. 1419 - 1430
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Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

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