Chronic Pain, Alcohol and Other Drug Use, and Alcohol and Drug Overdoses Among Addiction Treatment Patients

While drug overdose is the leading cause of accidental death in the US, the contributions of pain and alcohol (particularly when combined with other central nervous system depressants) have not yet been well described. The authors examined whether past nonfatal overdose was more likely among residential addiction treatment patients with pain, and examined the characteristics of alcohol or drug* overdose among those with and without pain. Cross sectional, self-reported data were analyzed from 739 patients at a large residential treatment center in Michigan between 2014 and 2016.

• The median age of participants was 37 years with most being male (74%), white (67%), and recommended for residential treatment by the criminal justice system (95%).
• 72% of the study sample reported pain (69% chronic pain only, 8% acute pain only, 23% both acute and chronic pain).
• Among people with alcohol use, approximately 83% of participants reported at least 1 previous nonfatal alcohol overdose (median=5). Past chronic pain and drug use were associated with an increased likelihood of nonfatal alcohol overdose.
• Among participants with drug use, 54% reported at least 1 previous episode of nonfatal drug overdose (median=1). Non-medical prescription opioid use, depression, and younger age were associated with an increased likelihood of nonfatal drug overdose.
• Individuals with pain were also more likely to combine numerous drugs with alcohol prior to overdose, compared with those without pain.

*Defined as “lifetime history of heroin, methadone, nonprescribed opioids/narcotic analgesics, barbiturates, sedatives, hypnotics, tranquilizers, amphetamines, ecstasy, cannabis, hallucinogens, phencyclidine, ketamine, inhalants, or ‘any other drugs.’”

Comments: This study has important limitations that impact its generalizability, including its single-site, cross-sectional, self-reported study design and an inability to distinguish the timing between overdose and pain onset. However, the findings emphasize a high prevalence of nonfatal alcohol overdose among the study’s patient population and suggest pain to be a significant contributing factor. Addiction treatment and overdose prevention interventions should incorporate appropriate assessment and treatment of pain, including education about the risks of polysubstance use.

Seonaid Nolan, MD

Reference: Fernandez AC, Bush C, Bonar EE, et al. Alcohol and drug overdose and the influence of pain conditions in an addiction treatment sample. J Addict Med. 2019;13(1):61–68.