Patients at Risk: Study Attempts to Predict Opioid Usage

New findings help focus patient education and provider efforts in offering non-opioid treatments to those at higher risk of opioid use and potential addiction

One of the most obvious ways to stop addiction is to never use the substance in question in the first place. However, when that substance is a medication being prescribed for a painful health issue, that may not be so easy. If the potentially addictive medication is not given – then what? The patient still needs treatment.

In the case of the current opioid epidemic, a great deal of attention is being given to the various treatment options being utilized for pain relief, including prescription painkillers, and why some individuals become addicted while others do not. Back and neck pain are commonly known to lead to opioid prescriptions and are a primary cause of disability as well as expensive to treat. Previous studies have revealed some commonalities among opioid patients that could help physicians and individuals in combating the opioid crisis.

In a study released in the March-April 2018 issue of the Journal of Manipulative and Physiological Therapeutics, researchers suggest that patient characteristics and preferences could point to what drives opioid usage as a method of pain relief and may even provide insight into predicting who may be more vulnerable to opioid use.1

Researchers utilized information from a nationally representative survey of US adults conducted by the Gallup Organization in the spring of 2017. They analyzed the “relationship between self-reported use of opioids by patients with neck and back pain and their demographic characteristics, pain characteristics, treatment preferences, and recollection of their physicians’ opinions regarding treatment options.”  Of the 6,305 individuals surveyed, 1,680 (27.7%) reported experiencing neck or back pain that was significant enough that they saw a healthcare professional within the previous year.

The individuals in this category were then asked for information regarding:

  • Duration of pain
  • Medication treatment preference
  • History regarding pain medications
  • Recall of their physician’s opinions about different treatments for pain
  • Use of opioids for pain relief
  • Pain duration (1 year or less and more than 1 year)
  • Age (classified into 4 groups:18-34, 35-49, 50-64, and 65 and older)
  • Medicaid insurance status
  • Educational attainment level (less than college educated, college educated or more than college)
  • Concurrent use of benzodiazepine status (Benzodiazepines are depressants that produce sedation, induce sleep, relieve anxiety and muscle spasms, and prevent seizures.)2

The data was then analyzed in a variety of ways.  They looked at each patient characteristic individually as well as combined.  Overall, there were a number of things these individuals had in common, such as:

  • 66% – Married
  • 73% – 50 years of age or older
  • 91% – White
  • 57% – Achieved less than a college education
  • 78% – Pain that lasted more than 1 year
  • 74% – Preferred to use other treatment prior to medications
  • 77% – Had seen a chiropractor at some point during lifetime

Further analysis revealed patients were MORE likely to have used opioids in the previous year, if they had one or more of these characteristics:

  • Had pain that had lasted for 1 year or less
  • Concurrently used benzodiazepines
  • Carried Medicaid as an insurance source
  • Indicated a preference of pain medications prescribed by a doctor to treat physical pain
  • Had no college education

As might be expected with increased age, those aged 65 and older were more likely to have used opioids than those 18-34 years of age.  However, generally speaking, the perception of their medical doctors’ opinions regarding treatment options had no significant association with their opioid usage.  While the authors note that additional research in this area is needed due limitations of the study (self-reported data, etc.), they concluded that the information should be considered in the development of strategies to prevent opioid use.

Although, the study results reflect that the majority of US adults are on board with the use of other treatments prior to medications, there are still many opioid prescriptions being written.  In these cases, making sure the patient is informed and active in the decision-making process may help increase the number of those who choose safer alternatives.3  To do this, specific groups as highlighted by this study, should be a focus for campaigns in order to make the most impact, including those aged 65 or older, who have shorter-term spinal pain, who desire medication treatment for pain relief, and who use benzodiazepines.  Educational materials and efforts should also be designed to be understood by populations without a college education and/or who are Medicaid insured.

Recent efforts to address the US opioid epidemic have resulted in new and revised guidelines being established by leading authorities advising doctors and patients to utilize non-pharmaceutical treatments before resorting to opioids.  (See what the CDC and the FDA have stated in their updated recommendations.)  Recognizing these recommendations and considering drivers such as those identified in this study, health care providers should be more aware and make a stronger effort to educate high-risk patients when providing information on the dangers of opioids and other viable pain relief options such as chiropractic and acupuncture to their patients.

Chiropractic is a safe, natural, non-pharmaceutical option for neck and back pain.  Your doctor of chiropractic (DC) can perform a full exam, order any needed diagnostic tests and develop a treatment plan that is catered to your individual health situation.  If treatment beyond chiropractic care is warranted, your DC can refer you to another health care provider and coordinate care as needed so that you receive the best possible outcome.  Beyond the initial pain relief, your chiropractor can provide you with stretches and exercises as well as dietary recommendations to help speed recovery and support a healthy lifestyle to help prevent recurrence.

If you are experiencing back or neck pain or chronic pain, try #chiropractic1st.  You may be surprised at how soon you can be feeling relief and getting back to an active lifestyle. If you do not have a chiropractor, you can find a TCA member doctor at


1 Weeks WB, Goertz CM, Long CR, Meeker WC, Marchiori DM.  Association Among Opioid Use, Treatment Preferences, and Perceptions of Physician Treatment Recommendations in Patients With Neck and Back Pain.  Journal of Manipulative and Physiological Therapeutics.  Volume 41, Issue 3, Pages 175–180.

2 U.S. Drug Enforcement Administration Drug Fact Sheet: Benzodiazepines.

3 Dieleman JL, Baral R, Birger M, et al. US spending on personal health care and public health 1996-2013. JAMA. 2016; 316: 2627–2646.


This article is being shared as part of TCA’s
“Realign Your Thinking” public-awareness campaign – 
helping Tennesseans understand what chiropractic care offers
and the positive role it plays in the overall health care system.