Does Report of Craving Opioid Medication Predict Aberrant... : The Clinical Journal of Pain (original) (raw)

Original Articles

Does Report of Craving Opioid Medication Predict Aberrant Drug Behavior Among Chronic Pain Patients?

Wasan, Ajay D. MD, MSc*; Butler, Stephen F. PhD†; Budman, Simon H. PhD†; Fernandez, Kathrine MBA†; Weiss, Roger D. MD‡ §; Greenfield, Shelly F. MD‡ §; Jamison, Robert N. PhD*

Departments of *Anesthesia and Psychiatry, Pain Management Center, Brigham and Women's Hospital

§Psychiatry, Harvard Medical School, Boston

†Inflexxion Inc, Newton

‡Alcohol and Drug Abuse Treatment Program, Mclean Hospital, Belmont, MA

Supported in part by grants (DA015617, Butler, PI; K23 DA020681, Wasan, PI; and K24 DA022288, Weiss) from the National Institute on Drug Abuse, from the National Institutes of Health, Bethesda, MD and Arthritis Foundation (Investigator Award; Wasan, PI).

Reprints: Robert N. Jamison, PhD, Departments of Anesthesia and Psychiatry, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (e-mail: [email protected]).

Received for publication March 21, 2008; revised June 16, 2008; accepted July 22, 2008

Abstract

Objective

To examine the relationship between the self-report of craving prescription medication and subsequent opioid misuse among chronic pain patients prescribed opioids for pain.

Methods

Six hundred thirteen patients taking opioid medication for chronic noncancer pain were asked how often they have felt a craving for their medication on a scale from 0=never to 4=very often. All participants completed a series of baseline questionnaires. After 6 months the participants were administered a structured prescription drug use interview (Prescription Drug Use Questionnaire), and submitted a urine sample for toxicology assessment. Their treating physicians also completed a substance misuse behavior checklist (Prescription Opioid Therapy Questionnaire).

Results

Three hundred thirty-seven participants (55.0%) reported that they never felt a craving for their medication, whereas 276 (45.0%) reported some degree of craving their medication (seldom to very often). Those who reported craving their medication were significantly more often male (P<0.01), unmarried (P<0.05), had lower scores on social desirability (P<0.001), and had been prescribed opioids for a longer time (P<0.05) than those who did not report craving medication. At 6-month follow-up, those who reported craving their medication showed higher scores on the Prescription Drug Use Questionnaire (P<0.001), had a higher incidence of physician-rated aberrant drug behavior on the Prescription Opioid Therapy Questionnaire (P<0.05), showed a higher frequency of abnormal urine toxicology screens (P<0.001), and more often had a positive Aberrant Drug Behavior Index (P<0.001).

Discussion

These results suggest that self-reported craving is a potential marker for identification of those at risk for opioid medication misuse.