Prescription drug abuse, particularly opioid addiction, is one of the biggest public health crises of our time. But why are so many people struggling with addiction? According to a new study published in the Journal of General Internal Medicine, chronic pain plays a big role.
Researchers at Boston University School of Medicine and Boston Medical Center discovered that the majority of patients misusing drugs and alcohol are in chronic pain and are using these substances to self-medicate.
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 further questions about chronic pain and their substance use.
Substance use was defined as the use of illegal drugs (heroin, marijuana, cocaine, etc.), excessive alcohol use, or the use of prescription drugs in ways other than they are prescribed.
The findings reveal that an overwhelming majority (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 patients 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,” said Daniel Alford, M.D., 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.
The new findings suggest that counseling focused only on informing patients about the negative consequences of drug and alcohol use falls terribly short and misses 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.