Short communicationLongitudinal analysis of pain and illicit drug use behaviors in outpatients on methadone maintenance
Introduction
Surveys suggest that 37–80% of the 301,551 (SAMHSA, 2012) patients receiving methadone maintenance treatment (MMT) in the U.S. have clinically significant chronic pain (Barry et al., 2009a, Dhingra et al., 2013, Jamison et al., 2000, Nielsen et al., 2013, Peles et al., 2011, Peles et al., 2005, Pud et al., 2012, Rosenblum et al., 2007, Rosenblum et al., 2003, Trafton et al., 2004). Studies in these and other populations with substance use disorders (SUDs) suggest that unrelieved pain may be linked to poorer addiction-related outcomes (Brennan et al., 2005, Caldeiro et al., 2008, Larson et al., 2007, Peles et al., 2005, Potter et al., 2008, Pud et al., 2012, Rosenblum et al., 2003, Sheu et al., 2008, Trafton et al., 2004, Weiss et al., 2014). These associations, which raise concerns about the possibility that unrelieved pain or its consequences may trigger illicit drug use, have not been confirmed by other surveys showing no such association (Barry et al., 2009a, Barry et al., 2009b, Dhingra et al., 2013, Nielsen et al., 2013). Further studies are needed to clarify the potential linkages between pain experience and illicit drug use behaviors.
A hepatitis care coordination trial provided an opportunity for a secondary analysis of pain-related data from two MMT programs (Masson et al., 2013, Perlman et al., 2014, Dhingra et al., 2013, Larios et al., 2014). Cross-sectional baseline data from this study revealed no statistically significant association between pain and illicit drug use behaviors (Dhingra et al., 2013). The one-year longitudinal follow-up data provided an opportunity for a more robust examination of this relationship. The Institutional Review Boards at Mount Sinai Beth Israel and the University of California in San Francisco approved the analysis.
Section snippets
Patient selection and procedures
Patients in New York City and San Francisco who were enrolled in two MMT programs participated in a one-year randomized controlled trial of a hepatitis prevention intervention. Selection criteria, enrollment procedures, study interventions, and primary outcomes have been described previously (Dhingra et al., 2013, Larios et al., 2014, Masson et al., 2013, Perlman et al., 2014). All patients completed measures at baseline and 3, 9, and 12 months later.
Measures
Pain and illicit drug use were assessed at
Results
Baseline and longitudinal analyses used the total enrolled sample of 404 patients who provided complete data for the 1-year study period. The mean age was 45.4 years (SD = 9.8); 32.7% were women, and 34.7% were Non-Hispanic white. At baseline, 263 (65.1%) patients had no pain, 37 (9.2%) had non-clinically significant pain, and 104 (25.7%) had CSP. Patients with CSP were significantly older, more likely to be married, were enrolled in MMT longer, and had higher methadone dosages than those without
Discussion
This analysis revealed no association between episodes of CSP and the occurrence of current illicit drug use over the course of one year in a large and diverse group of patients enrolled in one of two MMT programs. This finding confirms the analysis of baseline data from the same study (Dhingra et al., 2013) and is consistent with several other published cross-sectional studies of chronic severe pain and pain of varying severity (Barry et al., 2009a, Barry et al., 2009b, Nielsen et al., 2013).
Role of funding source
This research was supported by NIDA, R01DA020781, R01DA020841, P30DA011041, P50DA009253, and U10DA015815 (Perlman, Masson).
Contributors
All authors have participated sufficiently in the work to take responsibility for authorship and publication. Lara Dhingra, Russell Portenoy, Martin Cheatle, David Perlman, and Carmen Masson made substantial contributions to the design, data collection, analysis, and writing of the manuscript. Jack Chen, Courtney McKnight, and Ashly Jordan made substantial contributions to the data collection and preparation and literature review. Tom Wasser made substantial contributions to the data analysis.
Conflict of interest
No conflict declared.
Acknowledgments
We wish to thank Dr. Randy Seewald for her assistance with the study, MMT staff at both programs, and the patients who participated in the study. We would also like to thank Lara Coffin who assisted with developing the complementary and alternative therapies data collection instrument, Christopher Young for his assistance with data collection at the Baron Edmond de Rothschild Chemical Dependency Institute, and Nicole Pepper, Arielle Morganstern, Adrienne Wente, Jessica Hall, and Nicholas Hengl
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