2023. Chronic Pain and Medical, Psychiatric and Drug Abuse Problems in Opioid Dependent Veterans
JA Trafton, Center for Health Care Evaluation, EM Oliva, Center for Health Care Evaluation, DA Horst, Center for Health Care Evaluation, JD Minkel, Center for Health Care Evaluation, KN Humphreys, Center for Health Care Evaluation

Objectives: Sixty percent of substance dependent patients enrolled in opioid agonist treatment have chronic pain conditions, yet pain disorders and their clinical consequences are rarely studied in substance dependent populations.  Accordingly, this study examines the correlates of chronic pain among veterans treated at 8 VA methadone/LAAM maintenance clinics.

Methods: Research staff interviewed 241 VA patients at treatment intake.  The interview comprised the Addiction Severity Index, the SF-36V, and a high-risk injection practices questionnaire.  Patients were divided into those reporting moderate to severe pain (n = 128), and those without significant pain (n = 113).  Groups were compared using ANOVA for continuous variables and chi-square analysis for categorical variables.

Results:  Relative to patients without significant pain, pain patients reported a different pattern of poly-substance abuse.   Pain patients did not differ from patients without pain in their use of heroin, alcohol, cocaine or needles, but did report greater misuse of opioid medications (p<.01), sedatives (p<.01), and cannabis (p<.01).  Additionally, pain patients reported more hospitalizations for medical problems (Mean: 4.9 vs 2.9, p=.01), and more days of medical problems in the last month (21.9 vs 7.42, p<.01).  Pain patients were more likely to be prescribed medication for medical (65% vs 40%, <.01) and psychiatric (30% vs 19%, p=.03) problems, to receive a medical disability pension (36% vs 14%, p<.01) and to report depression (54% vs 32%, p<.01), anxiety (59% vs 37%, p<.01) and suicidal ideation (45% vs 29%, p<.01).  Groups did not differ by race, religion, geographical location or education.

Conclusions: Pain conditions are not only highly prevalent in opioid dependent patients, but also predict more severe medical and psychiatric problems.  Pain conditions are also associated with an increased propensity for misuse of substances that have analgesic effects, suggesting that these patients' ongoing pain contributes to an altered and more severe pattern of drug-seeking behavior.  Chronic pain is another dual diagnosis that complicates the treatment of substance use disorders, and, therefore should be a focus of special attention during treatment.

Impact: Combined programs that address substance abuse and chronic pain may better serve this subpopulation of opioid dependent veterans.