Managing Pain in Patients with a History of a Substance Use Disorder

2018 ◽  
Author(s):  
Martin D. Cheatle
Keyword(s):  
Chronic Pain ◽  
Substance Use ◽  
Opioid Use Disorder ◽  
Mitigation Strategies ◽  
Scholarly Activity ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Health Crisis ◽  
Prescription Opioid Misuse

Patients with chronic pain tend to be complex and can present with multiple comorbidities, including anxiety, depression, functional disabilities, and substance misuse or abuse. The burgeoning rate of prescription opioid misuse and abuse and opioid-related fatalities has generated a great deal of scholarly activity on understanding the etiology of opioid misuse/abuse and developing risk assessment and mitigation strategies to curb this public health crisis. Balancing effective pain management and reducing the risk of opioid misuse/abuse and diversion can be a daunting endeavor, as is controlling pain in patients with pain and concomitant substance use disorders. This chapter provides an overview of the prevalence of opioid misuse/abuse in patients with chronic pain. It covers pharmacologic and nonpharmacologic therapies for patients with pain and co-occurring opioid use disorder and also discusses the challenges and opportunities to improve pain care and reduce misuse and abuse of opioids.

scholarly journals Screening for depression among a sample of US college students who engage in recreational prescription opioid misuse

2020 ◽  
Vol 10 (1) ◽  
pp. 59-65
Author(s):  
Robert E. Davis ◽  
Martha A. Bass ◽  
M. Allison Wade ◽  
Vinayak K. Nahar
Keyword(s):  
College Students ◽  
Substance Use ◽  
Depressive Symptomatology ◽  
Opioid Use Disorder ◽  
Screening Tools ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Positive Screen ◽  
Prescription Opioid Misuse

Background: Among student populations, literature has identified associations between prescription opioid misuse and symptoms of depression such as hopelessness, sadness, and emotional pain. Thus far, existing literature has yet to investigate associations between prescription opioid misuse and depression using validated screening instruments for depression when exploring such associations. The purpose of this study was to utilize a validated screening tool to explore quantifiable presence of depression among college students who engage in recreational prescription opioid misuse (RPOM). Additionally, gender differences in depression and co-occurring substance use are examined. Methods: Students (n = 104) of a large university in the Southeastern United States who reported ROM within the past 6 months completed instrumentation assessing demographics, substance use, as well as, screening tools for depression and possible opioid use disorder (OUD). Results: Positive depression screens were significantly higher among females, however, nearly56% of participants screened positive for major depression. Though high levels of co-occurring substance use were observed among the entire sample, males were significantly more likely to report cocaine use, more frequent use of alcohol and marijuana, as well as, exhibit a positive screen for disordered opioid use, at a rate 5 times that of their female counterparts. Conclusion: Students who engage in RPOM are a particularly heightened-risk subsample of the college population who exhibit high levels of depressive symptomatology and substance use behavior. Targeted programming and further investigations are needed among this specific population. Future studies are encouraged to utilize validated instruments when assessing depression among students.

scholarly journals Social Media as an Emerging Tool for Reducing Prescription Opioid Misuse Risk Factors (Preprint)

2018 ◽  
Author(s):  
Sean Young ◽  
Sung-Jae Lee ◽  
Hendry Perez ◽  
Navkiran Gill ◽  
Lillian Gelberg ◽  
...  
Keyword(s):  
Social Media ◽  
Chronic Pain ◽  
Online Community ◽  
Prescription Opioid ◽  
Control Group ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Online Behavior ◽  
Prescription Opioid Misuse

BACKGROUND Interventions are urgently needed to reduce prescription opioid misuse risk factors, including anxiety and concomitant use of sedatives. However, only 5 randomized controlled opioid intervention trials have been conducted, with none showing improvements in anxiety. OBJECTIVE We sought to determine the feasibility of using an online behavior change community, compared to a control Facebook group, to reduce anxiety and opioid misuse among chronic pain patients. METHODS 51 high-risk non-cancer chronic pain patients were randomly assigned to either a Harnessing Online Peer Education (HOPE) peer-led online behavior change intervention or a control group (no peer leaders) on Facebook for 12 weeks. Inclusion criteria were: 18 years or older, a UCLA Health System patient, prescribed an opioid for non-cancer chronic pain between 3 and 12 months ago, and a score of ≥ 9 on the Current Opioid Misuse Measure (COMM) and/or concomitant use of benzodiazepines. Participation in the online community was voluntary. Patients completed baseline and follow-up assessments on Generalized Anxiety Disorder screener (GAD-7), COMM, and frequency of social media discussions about pain and opioid use. RESULTS Compared to control group participants, intervention participants showed a baseline-to-follow-up decrease in anxiety, and more frequently used social media to discuss pain, prescription opioid use, coping strategies, places to seek help, and alternative therapies for pain. Both groups showed a baseline to follow-up decrease in COMM score. CONCLUSIONS Results support the feasibility of using an online community interventions as a low-cost tool to decrease risk for prescription opioid misuse and its complications. CLINICALTRIAL ClinicalTrials.gov: NCT02735785

Borderline Personality Disorder Features and Risk for Prescription Opioid Misuse in a Chronic Pain Sample: Roles for Identity Disturbances and Impulsivity

2019 ◽  
pp. 1-18 ◽  
Author(s):  
Caleb J. Reynolds ◽  
Noel Vest ◽  
Sarah L. Tragesser
Keyword(s):  
Chronic Pain ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Chronic Pain Patients ◽  
Prescription Opioid Misuse ◽  
Pain Patients

Although borderline personality disorder (BPD) is associated with both chronic pain and substance abuse, little research examines how BPD features in chronic pain patients may constitute a risk factor for misuse of prescription opioids, and no prior research has examined which particular component(s) of BPD might put chronic pain patients at risk—an oversight that undermines prevention and treatment of such problematic opioid use. In a cross-sectional study of patients in treatment for chronic pain (N = 147), BPD features were associated with several measures of prescription opioid misuse, even controlling for pain severity and interference. Specifically, the identity disturbances and self-harmful impulsivity facets of BPD were most consistently associated with opioid misuse, and exploratory analyses suggested that these factors may be interactive in their effects. Together, these results suggest that BPD features—especially unstable identity and self-harmful impulsivity—play a unique role in problematic prescription opioid use in chronic pain settings.

scholarly journals Prescription opioid misuse motive latent classes: outcomes from a nationally representative US sample

2020 ◽  
Vol 29 ◽  
Author(s):  
Ty S. Schepis ◽  
A. S. De Nadai ◽  
J. A. Ford ◽  
S. E. McCabe
Keyword(s):  
Substance Use ◽  
Pain Relief ◽  
Prescription Opioid ◽  
Latent Classes ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Emotional Coping ◽  
The Us ◽  
Prescription Opioid Misuse ◽  
Prescription Opioid Use

Abstract Aims Prescription opioid misuse (POM) contributes to a larger opioid crisis in the US and Canada, with over 17 000 US POM-related overdose deaths in 2017. Our aims were to (1) identify specific profiles of respondents based on POM motives using the US National Survey on Drug Use and Health (NSDUH) and (2) compare profile respondents on sociodemographics, substance use and mental and physical health outcomes. Methods Analyses included 2017–18 NSDUH respondents with data on POM motives (n = 4810). POM was defined as prescription opioid use in a way not intended by the prescriber, including use without a prescription, in larger amounts or more frequently. Nine POM motives for the most recent episode were assessed, including ‘to relieve physical pain’ and ‘to get high’. Latent classes, based on POM motives, were estimated. Classes were compared on sociodemographics, substance use and physical and mental health outcomes. Results Eight latent classes were identified (in order of prevalence): pain relief only, relax-pain relief, sleep-pain relief, multi-motive, high, experimenter, emotional coping and dependent/hooked. Compared to the pain relief only group, the high and multi-motive classes had higher odds of all substance use outcomes, with the dependent/hooked class having higher odds on all but one outcome. Six of the eight classes had higher odds of past-year mental health treatment and suicidal ideation than the pain relief only class. Conclusions Screening for pain, pain conditions, problematic substance use and psychopathology are recommended in those with any POM. While those in the dependent/hooked, multi-motive and emotional coping classes are most likely to have prescription opioid use disorder (OUD), screening for OUD symptoms in all individuals with POM is also warranted.

Demographic characteristics, medical and psychiatric history of patients with prescription opioid use disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S300-S301
Author(s):  
S. Herrera ◽  
A. Riquelme ◽  
T. León ◽  
M. Babul
Keyword(s):  
Opioid Analgesics ◽  
The United States ◽  
Opioid Use Disorder ◽  
Demographic Characteristics ◽  
Prescription Opioid ◽  
Psychiatric History ◽  
Opioid Use ◽  
History Of ◽  
Competing Interest ◽  
Prescription Opioid Misuse

IntroductionOver the past two decades the prescription of opioid analgesics has increased with a subsequent escalating in prescription opioid misuse. It is estimated that 4.5 million (2.5%) of the United States of America population abuse of pain relievers; opioids are among the most commonly.In Chile there are few reports about the prevalence of opioid use disorder.ObjectivesThe aim of this study is to describe the demographic characteristics, medical and psychiatric comorbidity of patients that suffer from opioid addiction.Patients and methodsThis transversal study examined data of 7 patients with opioid use disorder (OUD; DSM-5) that consulted at the addiction unit of “Red de Salud, Pontificia Universidad Católica de Chile”, between November 2013 and October 2015. Data included: demographics, medical and psychiatric history, laboratory and imaging tests.ResultsOf all the patients, 57% were men, 25 to 67 years of age, 43% between 35-40 years; 57% were married; 57% had completed studies at university. 43% had also alcohol use disorder, 28% marijuana, 28% cocaine and 28% benzodiazepines than in most cases began before OUD. In addition; 57% had medical comorbidity among which stand out obesity (17%), osteoarthritis (17%) and chronic low back pain (17%). Eighty-three percent require hospitalization. Twenty-eight percent had abnormal liver tests and one patient had positive hepatitis B core antibody. Opioids used were: morphine(14%), codeine (43%), tramadol (42%).ConclusionThese results emphasize on the misuse of prescription opioids analgesics, the complexity of patients with OUD and the prevalence of other substance use disorder that precedes and accompany OUD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Opioid use disorder and chronic pain: challenges for palliative care practice

2019 ◽  
Vol 25 (9) ◽  
pp. 453-457
Author(s):  
Brenda Peters-Watral
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Substance Use ◽  
Pain Management ◽  
Cancer Pain ◽  
Opioid Use Disorder ◽  
Care Practice ◽  
Care Providers ◽  
Opioid Use ◽  
Multiple Cancer

Along with a well-documented increase in opioid use disorder (OUD) and a rapidly escalating rate of fatal overdose in North America, inadequate management of chronic pain remains a pervasive problem. The increasing number of individuals living with OUD also experience multiple cancer risk factors, which are related to their substance use, while people with cancer diagnoses have similar risks of current or past addiction as the general population. Recent pain guidelines focus on chronic non-cancer pain and do not include recommendations for cancer pain management. Managing cancer pain at the end of life is more challenging in people with current or past substance use disorder (SUD), especially OUD. Addressing these challenges requires confronting stigmas and stereotypes, building knowledge among palliative care providers and assessing the risks and benefits of opioids for pain management on an individual basis in order to continue to provide the holistic care.

Effectiveness of a substance use treatment program for veterans with chronic pain and opioid use disorder

2021 ◽  
pp. 108635
Author(s):  
Ralph Ward ◽  
Yi-lang Tang ◽  
Robert Neal Axon ◽  
Jennifer Casarella ◽  
Natasha Whitfield ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Substance Use ◽  
Treatment Program ◽  
Opioid Use Disorder ◽  
Substance Use Treatment ◽  
Opioid Use
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