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Drug Alcohol Depend. 2019 Aug 22;204:107456. doi: 10.1016/j.drugalcdep.2019.02.036. [Epub ahead of print]

Pain severity and prescription opioid misuse among individuals with chronic pain: The moderating role of alcohol use severity.

Author information

1
Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, 67 President Street, Charleston, South Carolina, 29425 United States; University of Houston, Department of Psychology, 126 Heyne, Houston, Texas, 77204 United States. Electronic address: djpaulus@uh.edu.
2
University of Houston, Department of Psychology, 126 Heyne, Houston, Texas, 77204 United States.
3
University of New Mexico, Department of Psychology, Logan Hall, MSC03-2220, 1 University of New Mexico, Albuquerque, New Mexico, 87131 United States.
4
University of Houston, Department of Psychology, 126 Heyne, Houston, Texas, 77204 United States; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030 United States; HEALTH Institute, University of Houston, Houston, Texas, 77204 United States. Electronic address: mjzvolen@central.uh.edu.

Abstract

BACKGROUND:

Chronic pain is a public health problem associated with opioid misuse. Yet, it is important to understand factors underlying opioid misuse in the context of pain. Alcohol use is one factor to consider given past work documenting use of alcohol to manage pain. However, it is unknown whether alcohol use severity exacerbates the relation between pain and opioid misuse. This study sought to examine relations between pain and prescription opioid misuse and the moderating role of alcohol use severity in two online survey studies of individuals with chronic pain.

METHOD:

Individuals with chronic pain (study 1, n = 364; study 2, n = 437) were administered measures of pain, alcohol use, and opioid misuse.

RESULTS:

In study 1, there was a significant interaction of pain severity and alcohol use (b = 0.16, p < 0.001). Pain was significantly related to opioid misuse among those with higher (b = 1.50, p < 0.001), but not lower (b=-0.26, p = 0.430) alcohol use. In study 2, there was a significant interaction of pain severity and alcohol use (b = 0.03, p < 0.001). Pain was significantly related to opioid misuse among those with higher (b = 0.74, p < 0.001), but not lower (b = 0.07, p = 0.620) alcohol use.

CONCLUSIONS:

In two online samples, there was evidence of a novel interaction of pain severity and alcohol use severity in relation to opioid misuse. Although cross-sectional, results replicated in two studies. Pain severity was related to opioid misuse among those with higher but not lower alcohol use. Those who use alcohol, even below suggested cut-offs, may be more likely to misuse opioids when in pain.

KEYWORDS:

Alcohol; Chronic pain; Comorbidity; Opioids; Pain

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