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Patients who are prescribed opioids often display 1 or more aberrant prescription use behaviors (eg, requesting early refills, borrowing medication from family), which raise concern among healthcare professionals. Little is known about the sex differences in specific types of aberrant behaviors or sex-specific predictors of such behaviors. The current study is aimed to begin addressing this gap in the literature.A battery of anonymous, self-report assessments was administered to 121 (49 men, 72 women) chronic pain patients enrolled in an outpatient pain management clinic. Most of the participants were white women with an average age of 51.6 years (SD=13.2).Significantly more men than women were taking a prescribed opioid (91.7% vs. 77.8%, P=0.05). Women were significantly more likely than men to hoard unused medication (67.6% vs. 47.7%, P=0.04) and to use additional medications to enhance the effectiveness of pain medication (38.8% vs. 20.0%, P=0.04). A trend toward men using alternative routes of administration (eg, crushing and snorting pills) more often than women was observed (8.9% vs. 1.5%, P=0.08). Among men, high rates of aberrant prescription use behaviors were associated with current alcohol use and the use of oxycodone and morphine. Among women, use of hydrocodone was associated with high rates of aberrant prescription use behaviors.Some aberrant prescription use behaviors are common among chronic pain patients and may be sex-specific. Predictors of aberrant prescription use behaviors may also differ by sex. Additional research is needed to help identify aberrant prescription use behaviors that best predict sex-specific risk for developing opioid abuse or dependence.