Problems with alcohol or cannabis use may be uniquely associated with opioid misuse in adults with chronic pain, according to study results published in the International Journal of Behavioral Medicine.
A total of 440 adults (mean age, 38.44 years) who reported current moderate to severe chronic pain and opioid use were assessed for substance abuse problems with the Alcohol, Smoking, and Substance Involvement Screening Test; the Current Opioid Misuse Measure; the Severity of Dependence Scale; and the Graded Chronic Pain Scale. In the cohort, 55.8% and 39.1% of individuals were currently consuming alcohol and cannabis, respectively.
Age, sex, education, smoking status, other drug use, and pain intensity were all found to be significant predictors of current opioid misuse (P <.001), and there were significant main effects for alcohol problems (P <.001) and cannabis problems (P <.001) on current opioid misuse, resulting in a further 15% of variance.
A significant interaction between alcohol and cannabis use problems was found to account for another 1% variance (P =.002). Alcohol use problems were also found to be related to current opioid misuse in participants with high (P <.001) and low (P <.001) cannabis use problems.
Regarding severity of opioid dependence, age, sex, education, smoking status, other drug use, and pain intensity were found to be significant predictors (P <.001), and there were significant main effects for alcohol problems (P =.001) and cannabis problems (P <.001). The severity of opioid dependence was not further affected by adding the interaction between alcohol and cannabis use problems.
Study limitations include its cross-sectional nature.
“It is possible that alcohol- and cannabis-related problems may, in part, drive opioid-related problems in the context of opioid use for chronic pain. Future work that employs research methodology that can explicate causal pathways between the studied variables is needed,” concluded the study authors.
Rogers AH, Shepherd JM, Paulus DJ, et al. The interaction of alcohol use and cannabis use problems in relation to opioid misuse among adults with chronic pain [published online September 5, 2019]. Int J Behav Med. doi:10.1007/s12529-019-09813-3