MedicalResearch.com Interview with:
Hanna Grol-Prokopczyk PhD
Assistant Professor, Department of Sociology
University at Buffalo, SUNY
MedicalResearch.com: What is the background for this study?
Response: Studies examining predictors of prescription opioid use often have limited information about users’ socioeconomic status, their level of pain, and their opinions of opioids. Using unique data from the Health and Retirement Study’s 2005-2006 Prescription Drug Study—which includes information about older adults’ education, income, wealth, insurance type, pain level, and opinions of prescription drugs used—I was able to explore how socioeconomic factors shaped prescription opioid use in the 2000s, when U.S. opioid use was at its peak. I was also able to present a snapshot of how users of prescription opioids felt about these drugs before the declaration of an opioid epidemic.
MedicalResearch.com: What are the main findings?
Response: I found that respondents in the bottom wealth quartile had nearly twice the rate of prescription opioid use as wealthier respondents. While this higher rate of use was partially explained by higher pain levels and increased likelihood of Medicaid enrollment, these two factors together explained only 38.37% of the association. That is, even for the same level of pain and same category of insurance, the poor were still more likely to take prescription opioids.
Interestingly, this difference was not driven by education. In these data, there were no significant differences in use of or opinions of opioids by level of education. (This may be similar to the lack of association between education and smoking in the 1950s. Educational differences in smoking only emerged in subsequent decades, as information about the risks of smoking became more available. The same sort of change may be happening now with opioids.)
This study also found that in the years before the declaration of an opioid crisis, users of opioids seemed quite content with the drugs. Over 80% agreed that opioids were “very important” for their health, over 75% agreed that opioids were “the best available” drug for what they did, and fewer than 12% reported unpleasant side effects. There is no sign that a decade or so ago users of prescription opioids viewed them as dangerous, undesirable drugs.
MedicalResearch.com: What should readers take away from your report?
Response: Poor pain patients may be in a particularly vulnerable position in today’s pain treatment environment, since the drugs they have disproportionately relied on—opioid analgesics—are increasingly difficult to obtain, and since many other pain treatments (PT, acupuncture, CBT, etc.) may also be difficult to access, due to undercoverage by insurance and/or temporal or transportational challenges. Special efforts may be required to make sure that disadvantaged groups are both educated about the risks of opioids and given access to alternative pain treatments.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Research tracking changes in social patterns in pain, opioid use, and beliefs about opioids would be valuable, to identify groups that remain unduly exposed to the risks of opioids and/or who are having difficulty accessing alternate pain treatments.
Hanna Grol-Prokopczyk, PhD
The Journals of Gerontology: Series B, gby093,
https://doi.org/10.1093/geronb/gby093 13 August 2018
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