Which Pain Patients Are Most Likely to Abuse Opioids?

Posted on November 11th, 2014

Chronic pain is the accepted term for significant pain that lasts for anywhere from weeks to years instead of resolving rapidly with or without treatment. Opioid medications are a powerful class of prescription substances frequently used to ease the effects of serious and chronic pain. However, ongoing use of prescription opioids comes with a considerable risk for developing diagnosable symptoms of opioid abuse or opioid addiction. In a study published in October 2014 in the journal Drug and Alcohol Dependence, researchers from two American universities explored the role that opioid drug cravings and a preoccupation with opioid drug cues play in putting chronic pain patients at risk for opioid abuse.

Chronic Pain and Opioid Use

Forms of chronic pain common throughout the U.S. include recurring headaches, arthritis-related pain, cancer-related pain, lower back pain, nerve damage-related pain and pain not clearly stemming from any identified source. Some chronic, painful ailments tend to appear at the same time as other forms of chronic pain, including inflammatory bowel disease, TMJ (temperomandibular joint dysfunction), fibromyalgia and chronic fatigue syndrome. Apart from opioid and non-opioid medications, treatments for long-term pain problems include nerve stimulation, psychotherapy and acupuncture.

Opioid medications used to help people affected by chronic pain include hydrocodone (Vicodin), oxycodone (Percocet, OxyContin), fentanyl (Duragesic), morphine (Avinza, Astramorph) and hydromorphone (Dilaudid). When used regularly over time, all of these medications (indeed, all opioid substances) can trigger the onset of opioid dependence, a condition that makes the brain reliant on continued opioid intake. However, opioid-dependent people (especially those individuals using a medication properly under a doctor’s guidance) do not necessarily develop problems with opioid abuse and opioid addiction. The risks for a transition from opioid dependence to uncontrolled abuse and addiction are typically highest in people who disregard the dosing guidelines in their prescriptions or consume opioid medications without a prescription.

Drug Cues and Drug Cravings

Drug cues are external and internal reminders that substance users develop over time as they participate in habitual patterns of substance intake. External forms of these cues include such things as the surroundings where substance intake normally takes place, the paraphernalia commonly used while consuming drugs and the presence of drug-using friends and acquaintances. Internal forms of drug cues include the emotions and thought processes that typically precede substance use or appear during active episodes of substance use. Some drug users develop a preoccupation with drug cues that psychologists refer to as an attentional bias. Along with withdrawal symptoms, drug cues commonly promote and intensify drug cravings, the strong urges for substance intake that, when frequently present, often mark a transition into substance abuse/addiction.

Which Patients Are At Risk?

In the study published in Drug and Alcohol Dependence, researchers from the University of Utah and the University of North Carolina, Chapel Hill used a small-scale project involving 47 people to explore the ways in which drug cues and drug cravings increase the odds that prescription opioid-using chronic pain patients will develop an abusive pattern of opioid consumption. The researchers focused on the impact of the preoccupation with drug cues that characterizes attentional bias. All of the study participants were long-term, physically dependent users of legitimately prescribed opioid medications. Each participant completed screening tools designed to determine the severity of his or her pain symptoms and identify any abusive patterns of prescription opioid intake. In addition, each participant took a test designed to uncover a preoccupation with opioid-related drug cues. Next, all of the participants were weaned off of opioid use and underwent treatment for opioid dependence. Ninety days later, the researchers looked for signs of opioid abuse in each individual.

The researchers preliminarily concluded that a bias toward opioid drug cues is typical in chronic pain patients who develop a physical dependence on opioid use. However, the impact of this bias is not consistent in all individuals. Generally speaking, people with a relatively modest preoccupation with opioid drug cues have fairly low chances of becoming opioid abusers after undergoing treatment for opioid dependence. However, people affected by a prominent preoccupation with opioid drug cues have a strong chance of falling into a pattern of opioid abuse after going through opioid dependence treatment.

The study’s authors concluded that the severity of a patient’s chronic pain symptoms has no significant bearing on the odds of becoming an opioid abuser after receiving treatment for opioid dependence. They believe their findings indicate that a strong preoccupation with opioid drug cues while using a prescribed opioid medication is a potential predictor for later involvement in opioid abuse.

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