Substance Abuse Treatment for Chronic Pain Patients on Opioid Therapy Project Summary Prescription opioids are believed to be the most commonly abused drugs in the United States, and misuse of prescription opioids is prominent among the chronic pain population. However, there are few treatment resources for chronic pain patients who have a history of substance misuse. This proposal seeks to remedy that deficit, with the goal of reducing the rate of prescription opioid misuse among those demonstrating risk of opioid therapy noncompliance. In response to PA-06-339 on prescription drug abuse, we propose a randomized, controlled trial in patients with chronic back or neck pain who have been prescribed opioids for pain and show potential for or signs of substance misuse. We want to investigate whether a clinic-based substance abuse education and counseling intervention can improve deficits in compliance due to recurrent misuse. We will test a unique intervention for patients with chronic noncancer pain who show risk for and evidence of misuse of prescription opioids. We will recruit 84 back pain patients who have been prescribed opioids for longer than 6 months. Fifty six (N=56) high-risk patients who have evidence of opioid misuse based on urine screen results or behavior ratings will be randomized to either standard control treatment or experimental compliance treatment consisting of individual and group motivational counseling, monthly diaries, urine screens, compliance checklists, and substance abuse education worksheets. Twenty-eight patients who meet criteria signifying no misuse will be recruited to a low-risk compliant control group. All patients will be followed for 6 months. This study will help determine whether frequent urine screens, regular reminders of the need for opioid compliance, substance abuse education, motivational counseling, and careful monitoring with electronic diaries will improve compliance with prescription opioids and lessen opioid abuse. A number of descriptive and behavioral variables including age, gender, pain intensity, evidence of somatic pathology that explains the pain syndrome, activity interference, substance abuse history, psychiatric comorbidities, and pain tolerance from quantitative sensory testing will also be examined with secondary analyses. This study represents a shift away from referring patients to a substance abuse treatment program. Instead, we propose to assess the benefits of compliance interventions within the medical setting.

Public Health Relevance

Chronic back pain patients are often dismissed from a pain center or a primary care practice when they are noncompliant with opioid therapy, instead of being offered treatments to reduce misuse and to improve compliance. Unfortunately, there are few treatment resources for such patients. This proposal seeks to remedy that problem, with the goal of reducing the rate of prescription opioid misuse among noncompliant patients through the use of novel monitoring, education, and counseling interventions.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Exploratory/Developmental Grants (R21)
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Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
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Aklin, Will
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Brigham and Women's Hospital
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