Smoking Linked to Longer Opioid Use

By Pat Anson, Editor

About one in five patients who are prescribed an opioid pain medication for the first time are still taking painkillers 90 days later, according to a small new study published in the Mayo Clinic Proceedings. Smokers and former smokers who were found to have the highest risk of using painkillers long-term.

Researchers at the Mayor Clinic studied a health database of residents in Olmsted County, Minnesota and identified 293 patients who were prescribed opioids in 2009. Nearly two-thirds were women who received their first opioid prescription after surgery, or some type of musculoskeletal pain or injury.

Most of the patients only needed one or two prescriptions and stopped taking pain medication. But 61 of them (21%) progressed to an “episodic” prescribing pattern in which they were still using opioids 90 days later. Nineteen patients (6%) were classified as “long term” users – which was defined as someone who had ten or more opioid prescriptions or at least 120 days of supply.

Women, Caucasians, people with a high school education or less, and patients with a history of depression or substance abuse had higher risks of long-term use.

But it was current or past smokers who stood out – nearly 74% of long-term opioid users had a history with tobacco. Nicotine is known to activate a group of nerve receptors in the brain, in a way very similar to how opioids and chronic pain activate them.

Researchers say the identification of potential risk factors like tobacco is an important tool for physicians, who should be careful about prescribing painkillers to patients with such histories.

“Before initiating a new opioid prescription, patients should be screened for past or current tobacco use and past or current substance abuse. This would allow the clinician to assess the risk of longer-term prescribing and would provide the opportunity to counsel the patient about these potential risk factors before actually receiving the initial prescription,” said lead author W. Michael Hooten, MD, a Mayo Clinic anesthesiologist.

"From a patient perspective, it is important to recognize the potential risks associated with these medications. I encourage use of alternative methods to manage pain, including non-opioid analgesics or other non-medication approaches. That reduces or even eliminates the risk of these medications transitioning to another problem that was never intended."

Not only does smoking raise the risk of longer opioid use, previous studies have shown it also increases your chances of having chronic pain.

A study of over 6,000 Kentucky women found that those who smoked had a greater chance of having fibromyalgia, sciatica, chronic neck pain, chronic back pain and joint pain than non-smokers. Women in the study who smoked daily more than doubled their odds of having chronic pain, while occasional smokers showed a 68% percent higher risk, and former smokers showed a 20% greater risk.

A large study in Norway found that smokers and former smokers were more sensitive to pain than non-smokers. Smokers had the lowest tolerance to pain, while men and women who had never smoked had the highest pain tolerance.