Markers of abuse liability of short- vs long-acting opioids in chronic pain patients: a randomized cross-over trial.
BACKGROUND
Abuse liability is thought to possibly be lower in long- than in short-acting opioids because lower peak serum levels may be less likely to induce psychoactive effects.


METHODS
We compared patient responses to extended-release morphine, hydrocodone plus acetaminophen, and placebo in a randomized, double-blind crossover study using markers of abuse liability. Patients indicated their craving for drugs on 5 visual analog scales (VASs), completed the Addiction Research Center Inventory, and underwent cue reactivity testing. To perform the latter, subjects watched a video intended to produce a positive or a negative affect, after which a vial of medication was or was not presented (the cue) and then indicated their craving for drugs on 5 different VASs (the reactivity).


RESULTS
Differences in Addiction Research Inventory scores were statistically significant but clinically unimportant. Neuropsychological test results were mixed and unrelated to the medications studied. Cue reactivity did not differ among conditions but was uniformly high.


CONCLUSIONS
Using several markers of abuse liability, long-acting opioids do not have lower abuse potential than do short-acting opioids or placebo. Although cue reactivity did not differ among the conditions, uniformly high results in these patients suggest that it may have some value as a component of abuse liability testing.
Wilsey
Barth L
BL
VA Northern California Health Care System, USA. blwilsey@ucdavis.edu
Fishman
Scott
S
Li
Chin-Shang
CS
Storment
Jeanna
J
Albanese
Anthony
A
D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016739:Behavior, Addictive / Q000175:diagnosis; D002908:Chronic Disease / Q000188:drug therapy; D016292:Procedural Sedation; D018592:Cross-Over Studies; D003463:Cues; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006853:Hydrocodone / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000175:diagnosis*; D010146:Pain / Q000188:drug therapy*; D012646:Self Administration; D013312:Stress, Physiological; D015813:Substance Abuse Detection / Q000379:methods*; D011795:Surveys and Questionnaires; D013997:Time Factors
D000701:Analgesics, Opioid; D006853:Hydrocodone; D009020:Morphine