Chronic pain, craving, and illicit opioid use among patients receiving opioid agonist therapy

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.

Dispensations of benzodiazepines, z-hypnotics, and gabapentinoids to patients receiving opioid agonist therapy; a prospective cohort study in Norway from 2013 to 2017

“…Being dispensed a benzodiazepine or z-hypnotic was particularly associated with being dispensed non-OAT opioids, and gabapentinoids, as well as methadone rather than buprenorphine as the type of OAT opioid. Chronic nonmalignant pain like pain in muscles and skeleton is highly prevalent in the OAT population using methadone as an OAT opioid and affects up to 68% in some studies [28][29][30][31]. Having chronic non-malignant pain on OAT is strongly associated with using benzodiazepines [26,27], and the presence of psychiatric comorbidities such as anxiety and depression [31].…”

Substance misuse in patients who have comorbid chronic pain in a clinical population receiving methadone maintenance therapy for the treatment of opioid dependence

“…Chronic pain is highly prevalent in treatment-seeking, opioid-dependent populations with between 36% and 68% affected (Barry et al, 2013;Tsui et al, 2016). Thus, chronic pain is an important clinical condition to be considered by addiction specialists.…”

Prevalence of pain and its socio-demographic and clinical correlates among heroin-dependent patients receiving methadone maintenance treatment

“…The relationship between pain and substance dependence is a complex and important clinical issue 1 . Studies have demonstrated that pain is very common among patients with various types of drug dependence disorders 2 – 4 , and chronic pain is associated with the development and relapse of opioid addiction, and craving for opioids 5 , 6 . Further, studies also found that chemically dependent patients with clinically significant pain (CSP) are more likely to self-medicate with other illicit drugs, alcohol, and non-prescribed drugs 2 , 7 – 10 .…”