Individuals with a history of non-medical opioid or stimulant use who lose access to their prescribed opioids are at elevated risk of turning to street drugs to manage chronic pain, according to a
study in the
American Journal of Preventive Medicine.
Why It’s Relevant
Concerns about opioid-related morbidity and mortality, increases in overdose deaths, and evolving clinical guidelines for the management of chronic pain have prompted a decrease in opioid prescribing since 2015. Individuals with a history of substance use in particular face difficulties in accessing and maintaining opioid prescriptions, which may lead to unintended consequences for those patients.
By the Numbers
- Researchers analyzed data from 300 adults with a lifetime history of non-prescribed opioid or stimulant (cocaine or methamphetamine) use who had received long-term opioids for chronic non-cancer pain over the past year.
- Fifty-nine percent lost access to opioid prescriptions for at least 30 days during the study period. These patients had 2.55 times the odds of increasing their cocaine use and 3.4 times the odds of increasing their methamphetamine use compared with patients who had continuous access to opioid prescriptions.
- In addition, patients who identified as Black/African American or who had depression had 2.89 and 2.23 times the odds of increasing the frequency of their cocaine use, respectively, compared with patients without these traits.
The Other Side
The study relied on self-reported data, which may be subject to biases. In addition, the study was conducted in a single safety-net health care system among individuals with a history of unregulated substance use—many of whom were using stimulants at baseline— which limits the generalizability of the findings.
Takeaway Message
“Although high levels of opioid prescribing have historically led to serious national consequences and increased overdose deaths, [our] findings emphasize the need for caution when adjusting pre-existing opioid regimens among vulnerable populations,” the researchers wrote. They added that their results both raise concerns about protocolized, insufficiently individualized opioid deprescribing and support patient-centered efforts to reduce reliance on opioids for pain management.
Related Information
Source
Leslie W. Suen, et al. Stimulant use after loss of access to prescribed opioids for chronic non-cancer pain. American Journal of Preventive Medicine. Published online May 27, 2026. doi: 10.1016/j.amepre.2026.108437
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