OBJECTIVES

There is some evidence that persistent opioid users (POU) have poor HRQoL as compared to non-opioid users (NOU). However, how much the patient-level characteristics contribute to the differences in HRQoL between POU and NOU is not known. We used Blinder-Oaxaca decomposition method to identify factors that contributed to the differences in HRQoL between POU and NOU among adults with CNCP.

METHODS

We used longitudinal data from multiple panels (2012 – 2015) of the Medical Expenditure Panel Survey. Adults older than 18 years, without cancer diagnosis, complete information for Short-Form 12 (SF12) questionnaire, and with self-reported CNCPs (arthritis, back/neck pain conditions, musculoskeletal conditions, or headache or migraine) were included in the study (N = 6,038). POU was defined as opioid use in two consecutive rounds during the baseline year. HRQoL was measured using Short Form-12’s physical health component (PCS) and mental health component (MCS) summary scores in the follow-up year. Oaxaca-Blinder linear regression decomposition technique was used to identify factors that contributed to differences in HRQoL between POU and NOU.

RESULTS

14% of our sample reported POU. POU had significantly lower PCS (33.7 vs 45.5; difference:11.8, p<0.001) and MCS scores (45.9 vs 50.0; difference:4.1, p<0.001) compared to NOU. Decomposition analysis revealed that a difference of 5.91 points (50.3%) in PCS was explained by differences in pain severity, multimorbidity, and employment status between POU and NOU. When baseline PCS was added to the model, it explained 61.1% of the difference in PCS between the groups. Since difference in MCS between the groups was not clinically meaningful, no decomposition analysis was performed.

CONCLUSIONS

Among adults with CNCP conditions POU had significant HRQoL burden. Poor HRQoL among POU can be mostly explained by higher rates of depression, anxiety, multimorbidity, and lower rates of employment in this group compared to NOU.