Far from chasing hedonistic highs, people who turn to drugs are often trying to stave away chronic bouts of pain, a study published this month in the Journal of General Internal Medicine suggests.
The authors analyzed survey data from around 25,000 patients who visited a primary care provider, ultimately focusing on 589 people who fit the criteria for drug abuse or illicit drug use. Of them, 87 percent reported chronic pain, with 74 percent adding that the pain interfered with their ability to function normally. And when asked outright, many of the patients admitted their drug use was an attempt to self-medicate the pain.
"While the association between chronic pain and drug addiction has been observed in prior studies, this study goes one step further to quantify how many of these patients are using these substances specifically to treat chronic pain,” said lead author Dr. Daniel Alford, an associate professor of medicine at Boston University, in a statement. “It also measures the prevalence of chronic pain in patients who screen positive for illegal drug use and prescription drug abuse."
The team’s findings are particularly relevant in light of the opioid abuse epidemic gripping the country. According to the National Institute on Drug Abuse, 2.1 million Americans suffered from a substance use disorder related to prescription opioid painkillers in 2012, with nearly a half-million more afflicted by heroin addiction. Indeed, the authors found that 81 percent of the 121 people who reported prescription opioid misuse did so to treat their pain.
Self-treatment was also a compelling reason for alcohol and marijuana use. Of the 576 people who reported illicit drug use, 51 percent gave self-medication as a reason; of the 265 who reported any amount of heavy drinking in the past three months, 38 percent did the same. So did 79 percent of the 57 high-risk alcohol users.
“Chronic pain and pain-related dysfunction were the norm for primary care patients who screened positive for drug use, with nearly one-third reporting both severe pain and severe pain-related dysfunction,” wrote the authors.
Aside from illuminating the often unseen struggles of drug users, the researchers also hope to promote a reevaluation of how medical providers treat patients suffering from drug addiction.
"Pain should be treated as part of the long-term strategy for recovery,” said Alford, who is the director of the Safe and Competent Opioid Prescribing Education program at Boston University School of Medicine as well as the director of the Clinical Addiction Research and Education Unit At Boston Medical Center. “If drugs are being used to self-medicate pain, patients may be reluctant to decrease, stop, or remain abstinent if their pain symptoms are not adequately managed with other treatments including non-medication-based treatments."
Source: Alford D, German J, Samet J, et al. Primary Care Patients with Drug Use Report Chronic Pain and Self-Medicate with Alcohol and Other Drugs. Journal of General Internal Medicine. 2016.