Stimulant Use After Loss of Access to Prescribed Opioids for Chronic Noncancer Pain

Since 2015, multiple investigations have identified the risks associated with deprescribing opioids for chronic pain. The use of nonprescribed cocaine and methamphetamine has also increased during this period, raising concerns about additional unintended consequences of opioid deprescribing. The objective was to determine the association between loss of access to prescribed opioids for chronic pain and subsequent cocaine or methamphetamine use.

The design was a prospective longitudinal cohort study from 2017 to 2021 of 300 adults with a lifetime history of nonprescribed opioid or stimulant (cocaine or methamphetamine) use who had received long-term prescribed opioids for chronic noncancer pain within the past year in San Francisco. The main measures were receipt of prescribed opioids for chronic pain and frequency of cocaine or methamphetamine use.

The odds of continuing prescribed opioids for chronic pain declined annually during the study (ORs=0.14-0.08, p<0.001). Loss of access to opioid prescriptions was independently associated with a subsequent increase in the frequency of cocaine (AOR=2.55, 95% CI=1.34, 4.87) and methamphetamine (AOR=3.40, 95% CI=1.60, 7.21) use. In addition, Black/African-American race (AOR=2.89, 95% CI=1.19, 7.01) and depression (AOR=2.23, 95% CI=1.09, 4.57) were associated with an increased frequency of cocaine use.

Loss of access to opioids prescribed for chronic pain was associated with an increased frequency of cocaine and methamphetamine use, highlighting another unintended consequence of opioid deprescribing that should be considered when individualizing care decisions.