title: Chronic pain, craving, and illicit opioid use among patients receiving opioid agonist therapy.
abstract: In a sample of patients receiving opioid agonist therapy, we evaluated whether having chronic pain was associated with (a) craving for opioids and (b) illicit opioid use.
  
  
  
  In a cross-sectional study of adults on buprenorphine or methadone maintenance recruited from an urban medical center, we examined any craving for opioids (primary dependent variable) in the past week and recent illicit opioid use (secondary dependent variable). Illicit opioid use was defined as a positive urine drug test (UDT) for opiates and chronic pain was defined as bodily pain that had been present for at least 3 months. Multivariable logistic regression models were fit for each outcome, adjusting for age, sex, and non-white race. Additional models adjusted for depression (PHQ-9) and anxiety (STAI).
  
  
  
  The sample included 105 adults on methadone or buprenorphine maintenance. Mean age was 43.8 (SD ±9.4)years; 48% were female and 32% non-white; 19% were on methadone. Chronic pain was present in 68% of the sample, 51% reported craving opioids in the past week, and 16% had a positive UDT. Chronic pain was associated with 3-fold higher odds of reporting craving in the past week (aOR=3.10; 95% CI: 1.28-7.50, p-value=0.01). The relative odds for having a positive UDT were not statistically significant (aOR=2.52; 95% CI: 0.64-9.90, p=0.18).
  
  
  
  In this sample of patients treated with opioid agonist therapy, those with chronic pain had higher odds of reporting craving for opioids. Chronic pain with associated opioid craving potentially places this population at risk for relapse.
authors.affiliation: Section of General Internal Medicine, Department of Medicine, Harborview Hospital/University of Washington School of Medicine, 325 9th Avenue, Box 359780, Seattle, WA 98104, United States. Electronic address: tsuij@uw.edu.
authors.forename: Judith I
authors.initials: JI
authors.lastname: Tsui
authors.affiliation: Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, 801 Massachusetts Ave., Second Floor, Boston, MA 02118, United States.
authors.forename: Marlene C
authors.initials: MC
authors.lastname: Lira
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave., Third Floor, Boston, MA 02118, United States.
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.affiliation: Data Coordinating Center, Boston University School of Public Health, 801 Massachusetts Ave., Third Floor, Boston, MA 02118, United States.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Winter
authors.affiliation: Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, 801 Massachusetts Ave., Second Floor, Boston, MA 02118, United States; Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave., Second Floor, Boston, MA 02118, United States.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Alford
authors.affiliation: Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, 801 Massachusetts Ave., Second Floor, Boston, MA 02118, United States; Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave., Second Floor, Boston, MA 02118, United States; Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave., Second Floor, Boston, MA 02118, United States.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Liebschutz
authors.affiliation: Department of Anesthesia, Brigham and Women's Hospital, Pain Management Center, 850 Boylston Street, Chestnut Hill, MA 02467, United States.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Edwards
authors.affiliation: Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, 801 Massachusetts Ave., Second Floor, Boston, MA 02118, United States; Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave., Second Floor, Boston, MA 02118, United States; Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave., Second Floor, Boston, MA 02118, United States.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002047:Buprenorphine / Q000627:therapeutic use; D059350:Chronic Pain / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D066249:Craving; D003430:Cross-Sectional Studies; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods / Q000523:psychology; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine; D008691:Methadone
keywords: Buprenorphine; Chronic pain; Methadone; Opioid agonist therapy; Opioid use disorder; Pain