Longitudinal analysis of pain and illicit drug use behaviors in outpatients on methadone maintenance.
BACKGROUND
Little is known about the experience of chronic pain and the occurrence of illicit drug use behaviors in the population enrolled in methadone maintenance treatment (MMT) programs.


METHODS
This is a secondary analysis of longitudinal data from two MMT samples enrolled in a randomized controlled trial of hepatitis care coordination. Patients completed pain, illicit drug use, and other questionnaires at baseline and 3, 9, and 12 months later. Associations were sought over time between the presence or absence of clinically significant pain (average daily pain ≥ 4 or mean pain interference ≥ 4 during the past week) and current illicit drug use (i.e., non-therapeutic opioid, cocaine or amphetamine use identified from self-report or urine drug screening).


RESULTS
Of 404 patients providing complete data, within-patient variability in pain and illicit drug use was high across the four assessment periods. While 263 denied pain at baseline, 118 (44.9%) later experienced clinically significant pain during ≥ 1 follow-up assessments. Of 180 patients (44.6%) without evidence of illicit drug use at baseline, only 109 (27.0%) had similar negative drug use at all follow-up assessments. Across four assessment periods, there was no significant association between pain group status and current illicit drug use.


CONCLUSIONS
This one-year longitudinal analysis did not identify a significant association between pain and illicit drug use in MMT populations. This finding conflicts with some earlier investigations and underscores the need for additional studies to clarify the complex association between pain and substance use disorders in patients in MMT program settings.
MJHS Institute for Innovation in Palliative Care, 39 Broadway, 12th Floor, New York, NY 10006, USA. Electronic address: LDhingra@mjhs.org.
Lara
L
Dhingra
Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003, USA; Department of Medicine, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003, USA; Center for Drug Use and HIV Research, New York University, 726 Broadway, New York, NY 10003, USA.
David C
DC
Perlman
Department of Psychiatry, University of California at San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
Carmen
C
Masson
MJHS Institute for Innovation in Palliative Care, 39 Broadway, 12th Floor, New York, NY 10006, USA.
Jack
J
Chen
Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003, USA; Center for Drug Use and HIV Research, New York University, 726 Broadway, New York, NY 10003, USA.
Courtney
C
McKnight
Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003, USA; Center for Drug Use and HIV Research, New York University, 726 Broadway, New York, NY 10003, USA.
Ashly E
AE
Jordan
Consult-Stat: Complete Statistical Services, 5754 Loyola Street, Macungie, PA 18062, USA.
Thomas
T
Wasser
MJHS Institute for Innovation in Palliative Care, 39 Broadway, 12th Floor, New York, NY 10006, USA; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
Russell K
RK
Portenoy
Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Reading Health System, West Reading, PA 19611, USA.
Martin D
MD
Cheatle
D000661:Amphetamine / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D059350:Chronic Pain / Q000188:drug therapy / Q000453:epidemiology*; D003042:Cocaine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D058850:Opiate Substitution Treatment; D010045:Outpatients; D012495:San Francisco / Q000453:epidemiology; D012651:Self Medication; D019966:Substance-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology*; D011795:Surveys and Questionnaires
D000701:Analgesics, Opioid; D000661:Amphetamine; D003042:Cocaine; D008691:Methadone
Addiction; Illicit drug use; Methadone maintenance; Pain; Pain management