A Health Beliefs Model of Long-Term Prescription Opioid Use for Chronic Pain

Although there is little evidence that very long-term (> 1 year) prescription opioid use is effective for non-cancer pain management, many patients continue prescription opioid use for many years. Interest in quitting and beliefs about opioid risks and benefits have not been measured in this patient population.

Semi-structured interviews were conducted with 20 non-cancer chronic pain patients who reported using daily prescription opioid use for > 1 year and either discontinued (n = 10) or continued use (n = 10) within the past 2 years. Grounded theory analysis was utilized to identify themes and to develop a theoretical model using the health beliefs model as a framework.

Patients who continued to use opioids tended to perceive themselves as not vulnerable to addiction, had pronounced fear of pain, and perceived opioids as the best option for pain control. Patients who quit reported concerns about becoming addicted, had experience with medication for addiction treatment, and valued non-opioid pain management.

Educating patients about the numerous physical and psychiatric consequences of chronic opioid use is warranted. Additional research is needed to measure physician beliefs about the risks and benefits of very long-term opioid use among adherent patients.