From the Guidelines
Opioid dependency risk factors include personal or family history of substance abuse, mental health disorders like depression or anxiety, younger age, history of legal problems, and regular contact with high-risk environments or individuals who use drugs, as well as medical factors such as chronic pain conditions requiring long-term opioid treatment, higher opioid dosages, and longer duration of use. The most recent and highest quality study, published in 2022 1, found that long-term opioid prescription was associated with a considerably increased risk for a new opioid use disorder diagnosis, with adjusted odds ratios of 15,29, and 122 at low, medium, and high opioid dosages, respectively. Key risk factors for opioid use disorder (OUD) include:
- Personal or family history of substance abuse
- Mental health disorders like depression or anxiety
- Younger age
- History of legal problems
- Regular contact with high-risk environments or individuals who use drugs
- Medical factors such as chronic pain conditions requiring long-term opioid treatment
- Higher opioid dosages (especially above 50 morphine milligram equivalents daily)
- Longer duration of use
- Specific medications like oxycodone and hydromorphone may carry higher dependency potential than others
- Early life trauma, poverty, unemployment, and limited social support further elevate risk
- Healthcare factors including multiple prescribers, inadequate monitoring, and poor patient education about proper medication use contribute to dependency development. Understanding these risk factors helps identify vulnerable individuals who may benefit from alternative pain management approaches, closer monitoring, lower opioid doses, shorter treatment durations, and earlier intervention with medications like buprenorphine/naloxone or methadone if dependency develops.
From the FDA Drug Label
Patients at increased risk for opioid abuse include those with a personal or family history of substance abuse (including drug or alcohol abuse or addiction) or mental illness (e.g., major depression)
The risk factors for opioid use disorder (OUD) include:
- Personal history of substance abuse
- Family history of substance abuse
- Mental illness, such as major depression 2
From the Research
Risk Factors for Opioid Use Disorder (OUD)
The following are some of the key risk factors for opioid use disorder (OUD):
- Younger age 3
- Male sex 3
- Lower educational attainment level 3, 4
- Lower income 3, 4
- Certain psychiatric disorders, such as other substance use disorders and mood disorders 3
- Psychological disturbances, including stress and anxiety 5
- Chronic pain 5, 6
- Posttraumatic stress disorder (PTSD) 4
- Genetics, with polygenic risk scores (PRS) positively associated with OUD 4
- Household income and education, which can moderate the risk of OUD 4
- Availability of opioids and access to non-opioid reinforcers 6
- Cognitive function deficits, resulting from chronic pain and substance abuse conditions 6
Patient-Specific Factors
Patient-specific factors associated with opioid misuse and OUD among patients with chronic pain include:
- Psychological factors, such as depression and anxiety 5
- Biological factors, such as dysfunctions in reward, appetitive, autonomic, and neurocognitive systems 5
- Social factors, such as social isolation and lack of support 6
Interplay between Genetics and Psychosocial Environment
There is an interplay between genetics and psychosocial environment in contributing to OUD risk 4. While polygenic risk scores alone do not yet have useful clinical predictive utility, psychosocial factors may help enhance prediction. These findings could inform more targeted clinical and policy interventions to help address this public health crisis.