The Initiation of Chronic Opioids: A Survey of Chronic Pain Patients

This study reports the results of a researcher-administered survey with 115 patients receiving chronic opioid therapy (>90 days) to obtain information regarding how chronic opioid therapy was started. Chronic opioids were started after surgery (27.0%, 95% confidence interval [CI], 18.5–35.5) or for the treatment of acute injury-related pain (27.0%, 95% CI, 18.5–35.5). Many who initiated opioid therapy after surgery reported postoperative complications (61.3%, 95% CI, 50.8–71.8) and many with injury-related pain reported follow-up corrective surgery (58.1%, 95% CI, 47.5–68.7), which led to the continuation of opioids. A large percentage of patients had concurrent depression (43.5%, 95% CI, 34.0–53.0) and anxiety (23.5%, 95% CI, 15.3–31.7). Many participants had a medical history of aberrant drug-related behavior (32.5%, 95% CI, 23.5–41.5) and self-reported history of addiction (21.7%, 95% CI, 13.7–29.7). Almost one-quarter reported taking opioids for a different indication than that for which opioids were started (95% CI, 26.6–45.0). Patients receiving long-term opioid therapy often transitioned to chronic use after starting opioids for the short-term treatment of postoperative or injury-related pain. It is not evident if a clear decision to continue opioids on a chronic basis was made. This survey provides insight as to how chronic opioid therapy is started, and may suggest opportunities for improved patient selection for opioid therapy. This article explores the reasons why patients using chronic opioid therapy (>90 days) initiated opioid medications. The results of this study may help clinicians better select patients for chronic opioid therapy. •Chronic (>90 days) opioid users (n = 115) were surveyed about their initial prescription.•Patients used opioids for postoperative (27%) and injury-related pain (27%).•Surgeons (30%), pain (29%), and primary physicians (21%) were the prescribers.•Patients initiated opioids without a clear treatment plan or opioid agreement.•Twenty-four percent were taking opioids for a different indication than the initiating reason.