Chronic pain patients on buprenorphine who struggle with physical discomfort used more cannabis and alcohol | Research

The takeaway

Among people with chronic pain receiving buprenorphine for opioid use disorder, those with lower tolerance for physical discomfort used cannabis and alcohol more frequently.

Addiction medicine specialists, pain management clinicians, and researchers studying polysubstance use in OUD treatment

41% of buprenorphine patients used cannabis in past 30 days

What the researchers found

In 163 chronic pain patients on buprenorphine for OUD, higher discomfort intolerance (difficulty tolerating uncomfortable physical sensations) was associated with more frequent cannabis use (IRR 1.11) and alcohol use (IRR 1.14). Discomfort avoidance (behavioral tendency to avoid discomfort) showed no such association.

Why it matters

Understanding why people in OUD treatment use other substances can inform strategies to improve treatment retention and address the intersection of chronic pain and substance use.

The numbers in context

163 participants; mean age 45; 86% White; 41% used cannabis in past 30 days; 24% used alcohol; discomfort intolerance associated with cannabis use (IRR 1.11, p = .016) and alcohol use (IRR 1.14, p = .022)

How the study worked

Cross-sectional analysis of baseline data from the TOPPS intervention trial, using negative-binomial regression models adjusted for demographics, pain interference, depression, anxiety, and cigarette use among 163 chronic pain patients on buprenorphine.

What this study cannot tell us

Cross-sectional design cannot determine causality; predominantly White sample limits generalizability; self-reported substance use; baseline data only without longitudinal follow-up

How to read the evidence

Cross-sectional analysis of baseline trial data with appropriate statistical adjustment but no longitudinal component.

When this study was published

2024 study

The bigger picture

Substance use during OUD treatment is common and associated with lower retention. This finding suggests that difficulty tolerating physical discomfort, rather than avoidance behavior, drives some patients toward cannabis and alcohol as supplemental pain management.

Questions still open

Would improving discomfort tolerance skills reduce cannabis and alcohol use in this population? Does cannabis use help or hinder OUD treatment outcomes for chronic pain patients?

Common questions

Why might chronic pain patients on buprenorphine use cannabis?

This study found that the key factor was discomfort intolerance, meaning difficulty tolerating uncomfortable physical sensations. Patients who struggled more with physical discomfort used cannabis (and alcohol) more frequently, suggesting they may be supplementing their pain management.

How common was cannabis use among these patients?

41% of participants reported using cannabis in the past 30 days. Alcohol use was also notable at 24%. These rates highlight how common other substance use is among people being treated for opioid use disorder.

Read the original research

Associations of discomfort intolerance, discomfort avoidance, and cannabis and alcohol use among persons with chronic pain receiving prescription buprenorphine for opioid use disorder.

Drug and alcohol dependence, 265, 112472

View on PubMed ↗Publisher’s paper ↗

Citation

Haley, Danielle F; Stein, Michael D; Bendiks, Sally; Karzhevsky, Skylar; Pierce, Claire; Dunn, Ana; Herman, Debra S; Anderson, Bradley; Weisberg, Risa B. (2024). Associations of discomfort intolerance, discomfort avoidance, and cannabis and alcohol use among persons with chronic pain receiving prescription buprenorphine for opioid use disorder.. Drug and alcohol dependence, 265, 112472. https://doi.org/10.1016/j.drugalcdep.2024.112472