Patient factors that affect opioid use among adults with and without chronic pain

Res Social Adm Pharm. 2021 Jun;17(6):1059-1065. doi: 10.1016/j.sapharm.2020.07.036. Epub 2020 Aug 14.


Background: In recent years, inappropriate use of prescription opioids has become a national crisis. Prescription opioids can be an important tool for managing pain, but excessive dosages or extended use may lead to drug dependence, overdoses and mortality. Since the early 2000s, increased prescribing of opioids has been associated with marked increases in these adverse outcomes.

Objective: To determine patient characteristics associated with opioid use among adults with and without chronic pain treatment.

Methods: The study is based on a nationally representative sample of civilian noninstitutionalized adults without cancer from the Medical Expenditure Panel Survey (2014-2017). A multinomial logit regression analysis is used. Key patient characteristics are health attitudes. Self-reliant health attitude is agreement with the following statements: "I do not need health insurance," and "I can overcome illness without help from a medically trained person."

Results: Health-related attitudes affect both adults with and without chronic pain treatment similarly. Adults with self-reliant health attitudes are less likely to start and more likely to discontinue opioid use. Exercise is associated with higher probability of choosing no analgesic treatments over using opioids. Similarly, among adults who are using opioids for pain treatment, exercise is associated with higher probability of discontinuing opioid use in the year following opioid initiation.

Conclusions and relevance: Health related attitudes, self-reported mental health, and lifestyle choices such as exercise and smoking are associated with patients' choices among opioid and non-opioid treatments. These results can help clinicians guide patients towards non-opioid treatments.

MeSH terms

  • Adult
  • Analgesics, Opioid / adverse effects
  • Chronic Pain* / drug therapy
  • Drug Overdose* / drug therapy
  • Humans
  • Opioid-Related Disorders* / drug therapy
  • Pain Management


  • Analgesics, Opioid