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- Title
Craving mediates the association between momentary pain and illicit opioid use during treatment for opioid‐use disorder: an ecological momentary assessment study.
- Authors
Mun, Chung Jung; Finan, Patrick H.; Epstein, David H.; Kowalczyk, William J.; Agage, Daniel; Letzen, Janelle E.; Phillips, Karran A.; Preston, Kenzie L.
- Abstract
Aim: To assess the role of momentary pain on opioid craving and illicit opioid use among individuals receiving opioid agonist treatment. Design Observational study using ecological momentary assessment. Setting: The National Institute of Drug Abuse Intramural Research Program in the United States. Participants: Fifty‐six adults who qualified for opioid agonist treatment. Measurements Participants completed randomly prompted assessments of pain severity, stress, negative mood, opioid craving and illicit opioid use for a mean of 66 days [standard deviation (SD) = 27]. Urine samples were collected two to three times/week throughout. Findings Almost 70% of participants reported moderate average pain severity in the past 24 hours at intake and 35% of participants reported chronic pain. There were no significant differences in percent of opioid‐positive urine samples (P = 0.73) and average level of opioid craving during the study period (P = 0.91) among opioid agonist treatment only patients versus opioid agonist treatment patients with chronic pain. However, momentary pain severity significantly predicted concurrent opioid craving [B = 0.02, 95% confidence interval (CI) = 0.01, 0.04], over and above stress and negative mood. Momentary opioid craving, in turn, significantly predicted illicit opioid use that was assessed in the next moment [odds ratio (OR) = 1.72, 95% CI = 1.12, 2.64), while controlling for autocorrelation and the effects of pain, negative mood and stress. Momentary opioid craving significantly mediated the prospective association between momentary pain and illicit opioid use (95% CI = 0.003, 0.032). Exploratory analysis revealed that momentary pain severity also significantly moderated the momentary association between stress and opioid craving (B = 0.02, 95% CI = 0.00, 0.04), such that when momentary pain severity increased, the association between the two intensified. Conclusions: Among people receiving opioid agonist treatment, momentary pain appears to be indirectly associated with illicit opioid use via momentary opioid craving.
- Subjects
UNITED States; CHRONIC pain &; psychology; EVALUATION of drug utilization; SUBSTANCE abuse risk factors; CHRONIC pain; NARCOTICS; RESEARCH; SUBSTANCE abuse; NARCOTIC antagonists; PAIN measurement; SCIENTIFIC observation; AFFECT (Psychology); CONFIDENCE intervals; DESIRE; DRUG use testing; RISK assessment; DESCRIPTIVE statistics; DRUGS of abuse; URINALYSIS; ODDS ratio; PSYCHOLOGICAL stress
- Publication
Addiction, 2021, Vol 116, Issue 7, p1794
- ISSN
0965-2140
- Publication type
Article
- DOI
10.1111/add.15344