Majority of patients who misuse drugs and alcohol have chronic pain

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Boston University Medical CampusMay 10 2016

With opioid addiction and prescription drug abuse considered one of the biggest public health threats of our time in the U.S., many are asking why so many Americans are struggling with addiction to illegal drugs and prescription medications. New research suggests that chronic pain may be part of the answer.

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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Boston University Medical Campus

Posted in: Medical Research News | Medical Condition News | Pharmaceutical News

Tags: Addiction, Alcohol, Chronic, Chronic Pain, Drug Abuse, Drugs, Education, Heroin, Medicine, Opioid Addiction, Pain, Prescription Drug, Primary Care, Public Health, Research, Substance Abuse

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Restrictions Drive Pain Patients to Risky Behavior

Kim Miller says:

June 2, 2016 at 2:26 PM

Your study has pointed out the symptom of a problem created by overreaching laws and media hype, as well as restrictive guidelines that keep chronic pain patients from receiving adequate treatment for their issues. If you had done your study before 2012, your results would likely have yielded much different results. Due to the outrageous torturing of chronic pain patients, many have been forced to self medicate or, as many are reporting, commit suicide.

When your options are few and your life has become a 24-hour cycle of pain, you do what you have to in order to get out of bed and move around. I am certainly not condoning illegal use of any drugs, excessive use of alcohol or misusing prescription medications. I am merely stating that people left with no life due to pain, will seek a remedy that's possibly worse than the problems you're trying to stop by creating such restrictive guidelines, medical providers will no longer treat patients with chronic pain.

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Judie Bruno on Majority of patients who misuse drugs and alcohol have chronic pain

Judie Bruno says:

June 2, 2016 at 4:37 PM

Please start asking some real questions like are any drug addicts no longer abusing drugs with these policies because we know that Prohibition does not work? The country is so concerned over the raise in heroin addiction and you will find, if you really look, that the raise is directly connected to these policies because if a drug addict can't get the pills they want, they will and are turning to heroin and now our government is supporting the Drug Cartels who will get a drug addict anything they want just as the "Mob's" did for alcohol. Did we learn nothing from history?

Why is the life of a drug addict more important than the lives of those who are in pain? Why are politicians acting as doctors in the decisions of what is the best way to treat us?

Mothers can no longer care for their children and bread winners no longer able to support their families. Who is going to pay for that care and where will that money come from? Who is going to care for those like myself who strive to stay independent and live within the boundaries of our disabilities but can no longer do so without the pain relief we need?

Health Care in this country is going to fail under these policies and it must when doctors refuse to take on patients who are in pain, clinic are closing and good doctors can no longer treat their patients in the way they know is best without fear of prosecution? Who are they going to blame for this? Obama Care? Someone must be blamed for the failure of our health care system to deal with those who are in pain.

Chronic Pain is a disability and we are being discriminated against because of those who will and do abuse drugs just like any religion or race who is discriminated against because of the actions of a few. We need someone to stand for us, talk about us, do something for us in this losing war on drugs.

We are told that 13% of Veteran's abuse drugs but what about the 87% who need relief from pain and now can't get that relief? Chronic Pain can and does kill and those who can no longer deal with a life in pain 24/7 will take their own lives and Veterans are the most vulnerable after the horrors of war. America makes these Veterans and makes the pain they now live with and yet we are turning our backs on them and telling them there is nothing we can do for the pain they are in.

Why aren't pain patients given the same rights as others to decide what is the best care for their problems? Politics needs to stay out of our relationship between our doctors and the care we need.

Please do your jobs, do it right, look into the problems these policies are making that no one will talk about because of the fear of supporting drug addicts but we are NOT drug addicts, we are patients who need help.

Please look into the politics of all of this as we know the reasons behind this attack on pain medications after losing the war on Marijuana, which will become legal in this country, in order to validate their existence and the billions of dollars wasted in this losing war on drugs are now attacking those who are in pain. Look into the big pharmacies and the fight against them and yes, they need to be held responsible for never finding cures but only drugs that mask the symptoms to make more money but taking all of this out on those who's only sin is that they are in pain, is not the right way to fight any of these injustices.

Please, think of the quality of life of those who are suffering in pain and think of your families, your parents, your children and how you would feel if they were suffering in pain and told there is nothing that can be done.

Help us, help the millions of American's both Veterans and civilians alike who are actually being tortured because of these policies. Please look at all sides of this war on drugs and the dangers of drug abuse but remember, there are millions of us who need relief from our pain. They can't fix the problems, can't give us what we need to live with any kind of quality of life without the pain medications that are available so why are they torturing us?

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