A factor analytic study of two measures related to opioid misuse and abuse

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1 A factor analytic study of two measures related to opioid misuse and abuse The dramatic rise in opioid use in the US in recent years has captured national attention: In 2017, 17.4% of Americans received one or more opioid prescriptions, with the average being 3.4 prescriptions. Of those prescribed opioids, 8 to12% of patients exhibit addictive behavior. In the wake of this opioid epidemic, consideration of patient risk factors for problematic opioid use has profound implications for prevention and treatment. Opioid misuse has been associated with a number of risk factors including substance abuse, alcoholism, tobacco use affective dysfunction, personality disorder, conflict at home or with physicians, incarceration, and a history of ACE/trauma. A recent study found that 62% of patients who died from opioid overdose were previously treated for pain, while 38% had not. This study contrasted factorial dimensions of two distinct patterns associated with problematic opioid use. Methods: A prior study developed two substance abuse risk measures relevant to opioid misuse: One scale assessed a history of illicit drug use ( Addiction History ) and the other assessed problematic prescription analgesic craving ( Addiction Potential ). Both scales were subjected to factor analysis, and their factor structure was compared. Participants: The participants in this study were 527 patients in treatment for a physical injury, and 725 community members from 106 sites in 36 US states. The demographics of the 1252 combined participants approximated the U.S. Census for race, education, age, and gender. Participant ages ranged from 18 to 65 years. Results: A principal component analysis of the Addiction History items identified four components with eigenvalue>1. Item communalities ranged from 0.65 to Using the Promax method, the components were rotated to an oblique solution. Using a loading criterion of 4 as a cutoff, simple structure was achieved with the exception of one item loading on two factors. These components were subsequently identified as history psychological trauma and suicidality, impulsiveness and social dysfunction, a history of anger and self-destructiveness, and drug/alcohol abuse and incarceration. Overall, these components appeared to correspond to a number of the predictors identified by the literature review. Together these components accounted for 51% of the variance. A principal component analysis of the Addiction Potential items identified three components with eigenvalue>1. Item communalities ranged from.40 to.66. Using the Promax method, these components were rotated to an oblique solution. Using a loading criterion of 4 as a cutoff, simple structure was achieved. These components were subsequently identified as a 1

2 depressive reaction to a medical condition, dysfunctional pain coping, and craving analgesic medication. These components accounted for 49% of the variance. Discussion: The factors identified in this study suggest the possibility of two etiologies for opioid abuse and misuse: 1) an Addiction path, preceded by ACE/trauma, followed by impulsiveness, self-destructiveness, and illicit substance use; and 2) a Pain Patient path, associated with a painful medical condition, unrealistic expectations, high distress, and craving analgesics. As these two factors only intercorrelated.30, individuals with these distinct risk profiles may benefit from clinical interventions tailored to address their specific constellation of risk factors. 2

3 Addiction Potential Pattern Matrix a Component Sometimes my pain gets worse, but it never gets better My pain never changes I walk and move very carefully so I won't cause myself pain I worry about becoming dependent on prescription medication..675 i570_0_to_ If my pain goes away in one place, it usually gets worse somewhere else Looking at your whole life, how much of a problem have you had with being sick.483 or disabled? 204. I need medicine to kill my pain My life used to be much better than it is now This has been one of the worst times of my life My future looks bright to me When I think about my physical problems, I get depressed With the strong drugs available today, no one should have to feel any pain When I am in pain, I need to have someone take care of me I am addicted to prescription drugs..475 Addiction Hx Pattern Matrix a Component My use of alcohol or drugs has gotten me into serious trouble I have been ticketed for driving while using alcohol or drugs I have been treated for drug or alcohol abuse I have spent more than a week in jail At times in my life I have been called an alcoholic I have never abused alcohol or drugs..514 i574_0_to_ Even after setbacks, I still feel hopeful Sometimes I do things to hurt myself I have many violent thoughts I am a very self-destructive person In the past I have purposely harmed myself physically When I am mistreated, I get even I was molested when I was a child I have never been raped or sexually assaulted I was once the victim of such violence that I thought I might die I have attempted suicide in the past Sometimes I act before I think and then pay for it later I have done many reckless and stupid things I got into a lot of trouble when I was in school I was a good student People can make me angry just by hanging around

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