Chronic pain, craving, and illicit opioid use among patients receiving opioid agonist therapy. (1st September 2016)

• Record Type: Journal Article
• Authors: Tsui, Judith I.; Lira, Marlene C.; Cheng, Debbie M.; Winter, Michael R.; Alford, Daniel P.; Liebschutz, Jane M.; Edwards, Robert R.; Samet, Jeffrey H.
• Is Part Of: Drug and alcohol dependence. Volume 166(2016)
• Page Start: 26
• Page End: 31
• Publication Date: 2016-09-01
• Subjects: Opioid use disorder -- Pain -- Chronic pain -- Opioid agonist therapy -- Methadone -- Buprenorphine; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2016.06.024
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Among persons on methadone or buprenorphine, chronic pain was present in 68% and 51% reported craving opioids. Chronic pain was associated with 3-fold higher odds of reporting opioid craving in the past week. Chronic pain with associated opioid craving may place persons with treated opioid use disorders at risk for relapse. Abstract: Aims: In a sample of patients receiving opioid agonist therapy, we evaluated whether having chronic pain was associated with (a) craving for opioids and (b) illicit opioid use. Methods: In a cross-sectional study of adults on buprenorphine or methadone maintenance recruited from an urban medical center, we examined any craving for opioids (primary dependent variable) in the past week and recent illicit opioid use (secondary dependent variable). Illicit opioid use was defined as a positive urine drug test (UDT) for opiates and chronic pain was defined as bodily pain that had been present for at least 3 months. Multivariable logistic regression models were fit for each outcome, adjusting for age, sex, and non-white race. Additional models adjusted for depression (PHQ-9) and anxiety (STAI). Results: The sample included 105 adults on methadone or buprenorphine maintenance. Mean age was 43.8 (SD ±9.4) years; 48% were female and 32% non-white; 19% were on methadone. Chronic pain was present in 68% of the sample, 51% reported craving opioids in the past week, and 16% had a positive UDT. Chronic pain was associated with 3-fold higher odds of reporting craving in the past week (aOR = 3.10; 95% CI: 1.28–7.50, p -value = 0.01). The relative odds for having a positive UDT were not statistically significant (aOR = 2.52; 95% CI: 0.64–9.90, p = 0.18). Conclusion: In this sample of patients treated with opioid agonist therapy, those with chronic pain had higher odds of reporting craving for opioids. Chronic pain with associated opioid craving potentially places this population at risk for relapse.