Misuse of prescription opioids can occur for a variety of reasons, but one often overlooked risk factor is alcohol consumption. Even though previous research(www.cdc.gov) has indicated that about one in five deaths attributed to prescription opioid misuse also involved alcohol, the relationship between these behaviors hasn't been thoroughly examined -- until now.
A new study(www.ajpmonline.org) published online June 11 in the American Journal of Preventive Medicine found that between 2012 and 2014, more than 4.2 million Americans ages 12 and older misused prescription opioids. More than half of those people also engaged in binge drinking, and binge drinkers were nearly twice as likely to misuse prescription opioids as nondrinkers.
Given the prevalence of binge drinking and opioid misuse in the United States, the report's findings could have significant implications for family physicians in the way they screen and care for patients battling addiction to opioids, alcohol or both.
"Family physicians are well-positioned to identify and address binge drinking and opioid misuse," said Roger Zoorob, M.D., M.P.H., the Richard M. Kleberg Sr. professor and chair of the Department of Family and Community Medicine at Baylor College of Medicine in Houston. "The AAFP can be instrumental in disseminating tools, training and resources to increase physicians' knowledge, skills and confidence around addressing substance use."
- New research reveals that more than half of Americans ages 12 and older who have misused prescription opioids have also engaged in binge drinking.
- Binge drinkers were nearly twice as likely as nondrinkers to misuse prescription opioids after adjusting for factors such as age and sex.
- Family physicians have several resources available to screen and care for patients suspected of binge drinking and/or opioid misuse.
Methods and Results
For the study, CDC researchers analyzed data from the 2012, 2013 and 2014 National Survey on Drug Use and Health public use files for more than 160,000 respondents on their self-reported use of alcohol and prescription opioids during the past 30 days.
The surveys defined binge drinking as having consumed four or more drinks on the same occasion for females (or five or more drinks for males) and prescription opioid misuse as using an opioid without a prescription or only for the experience or sensation it caused.
The researchers compared prescription opioid misuse and binge drinking rates using a variety of social and economic factors. Among their findings:
- Prescription opioid misuse was most common among males, people ages 18 to 34, those with an annual family income of less than $20,000 and those without health insurance.
- Binge drinking was most common among males, people ages 18 to 34, white non-Hispanic adults and adults with some college education.
- For adolescents, rates of prescription opioid misuse were significantly higher among those who binge drank (8.1%) than among nondrinkers (1.1%) and those who consumed alcohol but did not binge drink (3.6%).
- Almost two-thirds of binge drinkers who reported misuse of prescription opioids were 26 or older.
Overall, the prevalence of prescription opioid misuse was 3.5 times higher among binge drinkers than nondrinkers and those who consumed alcohol but did not binge drink. After adjusting for factors such as age and sex, binge drinkers were 1.7 times more likely to misuse prescription opioids than nondrinkers.
Opioid misuse also increased with the frequency of binge drinking. In individuals who reported one or two binge drinking episodes during the past 30 days, the prevalence of prescription opioid misuse was 2.4%. In those who reported 10 or more binge drinking episodes, the prevalence rose to 6.5%.
FP Expert's Advice
Zoorob, who helped create the AAFP's alcohol screening practice manual, told AAFP News that when he encounters a patient he suspects of misusing opioids and/or binge drinking, he conducts a thorough history and looks for signs such as requests for early refills of prescriptions or prescriptions being filled at multiple pharmacies.
The first step in identifying a patient who may be misusing alcohol, Zoorob said, is to have a standardized screening process in place.
"Many times, patients are unaware that their drinking patterns are harmful, and a simple, brief intervention by the family physician has been shown to reduce unhealthy alcohol use in the primary care population," he said.
Zoorob encouraged family physicians to use a validated screening instrument -- such as the Alcohol Use Disorders Identification Test-Concise, or AUDIT-C,(www.integration.samhsa.gov) or the Single-Question Alcohol Screening Test(www.ncbi.nlm.nih.gov) -- to assess patients' alcohol use and then construct a protocol around that instrument to address alcohol misuse.
He also encouraged FPs to talk with their patients about the dangers of concurrent use of alcohol and opioids.
"Family physicians can help patients who personally use opioids (whether therapeutically as prescribed or illicitly) or those concerned about family members who use opioids by providing opioid overdose prevention education and prescribing naloxone(207 KB PDF) or by directing patients to opioid overdose prevention initiatives within their community," Zoorob said.
Additionally, he suggested that FPs design an atmosphere where patients can open up about what they're going through.
"Create an environment where patients feel comfortable discussing their substance use," said Zoorob. "Aim to reduce stigma, (and) always leave the door open for future discussions."
Related AAFP News Coverage
Research Shows Nation's Opioid Epidemic Is Far From Over
More Comprehensive Approach Is Needed to Reduce Opioid Use, Deaths
CDC Guideline for Prescribing Opioids for Chronic Pain(www.cdc.gov)