In a study that appears in the May issue of the Journal of
General Internal Medicine, researchers at Boston University School of
Medicine and Boston Medical Center have found that the majority of patients
misusing drugs and alcohol have chronic pain and many are using these
substances to "self-medicate" their pain.
According to the researchers, many illegal drugs such as
marijuana and heroin have pain-relieving properties.
The researchers screened approximately 25,000 patients in
primary care for illegal drug use and misuse of prescription medications.
Among these patients, 589 who screened positive for substance
use were asked questions about chronic pain and their substance use. Substance
use was defined as use of illegal drugs (heroin, marijuana, cocaine, etc.), use
of prescription drugs in ways other than prescribed or high risk alcohol use.
They found that 87 percent of those who screened positive for
illegal drug use, misuse of prescription drugs or heavy alcohol use suffered
from chronic pain.
Half of these patients graded the pain as severe. In the subgroup
that was using illegal drugs, 51 percent reported using one or more drug
specifically to alleviate physical pain.
In those using prescription drugs without a prescription or
using more than prescribed, 81 percent identified self-medication of pain as
the reason for misuse. With regard to high risk alcohol use, the majority (79
percent) did so to manage pain.
"While the association between chronic pain and drug
addiction has been observed in prior studies, this study goes one step further
to quantify how many of these patients are using these substances specifically
to treat chronic pain.
“It also measures the prevalence of chronic pain in patients
who screen positive for illegal drug use and prescription drug abuse,"
explained corresponding author Daniel Alford, MD, MPH, associate professor of
medicine and assistant dean of Continuing Medical Education and director of the
Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program at
BUSM. He is also the director of BMC's Clinical Addiction Research and
Education Unit.
The results of this study suggest that counseling focused only
on informing patients about the negative consequences of drug and alcohol use
may miss a key aspect of why people are using these substances.
"Pain should be treated as part of the long-term strategy
for recovery. If drugs are being used to self-medicate pain, patients may be
reluctant to decrease, stop, or remain abstinent if their pain symptoms are not
adequately managed with other treatments including non-medication-based
treatments," added Alford.
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This research was part of the ASPIRE study, which was funded
by the National Institute on Drug Abuse (RO1 DA025068) and the Massachusetts
Department of Public Health both of which received funding from the Center for
Substance Abuse Treatment (TI018311). Other support included the National
Center for Research Resources (UL1RR025771).
