Craving Could Indicate Potential Opioid Medication Misuse

Managing chronic pain can be quite difficult – to find the right combination of treatment and medications takes a lot of trial and error for many patients. One treatment that is becoming more common is using opioids (controlled drugs, narcotics) to try to lessen the pain. This means more people than ever have access to these medications and increases the potential of abuse.

Currently, it’s estimated that about three to 16 percent of the general public abuse substances of some sort, with a growing number abusing prescription opioids. Unfortunately, healthcare professionals don’t always have the proper training to identify drug addiction and drug-seeking behaviors. Not only can this be a problem by giving drug-abusing patients more of what they want, it can result in patients not being adequately treated because of the physicians’ concern of feeding the addiction. So, there are issues on both sides of the spectrum.

For the most part, patients who take opioids to manage their chronic pain don’t experience euphoria or cravings. Their medication helps relieve the pain. However, there are some people who do experience those euphoric effects. Because of the seriousness of opioid misuse, researchers have been working to see if they could identify which patients would be more vulnerable in order to prevent drug abuse.

Researchers are in general agreement that cravings are in important part of abuse, but they don’t know if the craving means the abuse is inevitable. As well, cravings are an important part of treatment, assessing cravings as they increase, stay steady, or decrease.

Earlier, a questionnaire called the Screener and Opioid Assessment for Patients with Pain (SOAPP) was developed to help patients report their progress, called self-reporting. Using the questionnaire, researchers found that five factors could help predict noncompliance (patients not following the medication regimen) and opioid misuse. They were: history of substance abuse, history of legal problems, craving for medications, heavy smoking, and mood swings.

Using the information gathered for the SOAPP, researchers refined the questionnaire and developed the SOAPP-R. The authors of this article wanted to compare the two studies where the first one did not include cravings while the second one did, looking to see if craving truly was a predictor for addiction or misuse.

Over 600 patients who had chronic pain and who were taking opioids were asked to rate their cravings for medications on a scale of zero to four, with zero being never and four being very often. Their average age was 50 years, ranging from 21 to 89 years). The majority (66.8 percent) had lower back pain. After six months, they were given a questionnaire called the Prescription Drug Use Questionnaire and their urine was tested for drugs. Their own doctors were asked to complete a checklist called the Prescription Opioid Therapy Questionnaire. Other questionnaires were also used to understand the patients’ history. The Brief Pain Inventory looks at the patients’ pain history, intensity, and location, as well as how much it affects their daily life. Zero means not at all and 10 means as much as possible. The Marlowe-Crowne Social Desirability Scale has 13 questions that tells doctors how likely a patient is to tell them what they want to hear versus what their real answer is.

At the end of the study, of the 613 patients, 337 (55 percent) reported that they didn’t have an cravings for the medication while 276 (45 percent) said they did. This group also showed the highest scores on the Prescription Drug Use Questionnaire and had higher ratings on the physician’s questionnaires as well. In addition, they also had a higher rate of abnormal urine test results for drugs. The cravings group had many more men in it than women, they were often unmarried, and many scored low on “social desirability.”

The authors point out that there are some flaws to the study, the first of which is the intent of the study. The authors went into the study meaning to look into assessing and validating the tools that predicted opioid misuse and not to address cravings, as they did in the results. They also felt that their questions were perhaps too vague for some patients to be interpreted the same by everyone. They also didn’t take into account patients who didn’t test positive for drugs in their urine but who still may have been abusing their drugs.

In conclusion, the authors felt that the findings did support the idea that patients who have chronic pain and who take opioids are at higher risk of abusing the drugs if they admit to cravings.