Abstract
Approximately 20 million Americans have some form of substance abuse disorder, and about one-third of the US population has used illicit drugs (Substance Abuse and Mental Health Services Administration office of Applied Studies 2007). Substance abuse is known to occur in 10–16% of outpatients in general medical practice, 25–40% of hospital admissions, and 40–60% of major trauma patients (Manchikanti et al. 2003, Rosenblatt and Mekhail 2005). In chronic pain management settings, illicit drug use has been reported in 14–34% of patients (Manchikanti et al. 2006). Among the illicit drugs, use of marijuana is reported most common, followed by that of cocaine, hallucinogens, and methamphetamines. Such high prevalence of illicit use, along with concerns of drug abuse and addiction, and its association with life-threatening pathophysiological effects, often has a negative influence on pain treatment. Pain patients who have current or remote histories of drug abuse present a multitude of medical and psychosocial issues that hinder pain and symptom management. Physicians are often not well-versed with the conceptual or practical issues related to addiction, which causes difficulty in treating these patients effectively. In chronic pain patients, the high incidence of illicit drug use is intimately linked to opioid and prescription drug dependence, as well as to the psychosocial, cultural, and environmental factors that affect these individuals.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Abraham H, Aldridge A, Gogia P. The psychopharmacology of hallucinogens. Neuropsychopharma 1996;14:285–98.
Abraham H, Aldridge A. Adverse consequences of lysergic acid diethylamine. Addiction 1993;88:1327–34.
Adams MP, Ahdieh H. Pharmacokinetics and dose-proportionality of oxymorphone extended release and its metabolites: results of a randomized crossover study. Pharmacotherapy 2004;24:468–76.
Adams MP, Ahdieh H. Single- and multiple-dose pharmacokinetic and dose-proportionality study of oxymorphone immediate-release tablets. Drugs R D 2005;6:91–9.
Ahdieh H, Ma T, et al. Efficacy of oxymorphone extended release in postsurgical pain: A randomized clinical trial in knee arthroplasty. J Clin Pharmacol. 2004;44:767–76.
Albertson TE, Derlet RW, Van Hoozen BE. Methamphetamine and the expanding complications of amphetamines. West J Med. 1999;170:214–9.
Albrecht CA, Jafri A, Linville, L, et al. Cocaine-induce penumopericardium. Circulation 2000;102:2792–4.
Alford DP, Compton P, Samet JH. Acute pain management for patients receiving maintenance methadone or buprenorphine therapy. Ann Intern Med. 2006;144(2):127–34.
Amass L, Kamien JB, Mikulich SK. Efficacy of daily and alternate-day dosing regimens with the combination buprenorphine-naloxone tablet. Drug Alcohol Depen. 2000;58:143–52.
American Academy of Pain Medicine. American Pain Society, American Society of Addiction Medicine. Definitions related to the use opioids for the treatment of pain [consensus document]. Glenview, IL, American Academy of Pain Medicine; 2001.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: Author; 1994.
Andres RL. Social and illicit drug use in pregnancy. In: Resnik RR, Ceasy R, editors. Maternal-fetal medicine. Philadelphia, PA: WB Saunders; 1993. pp. 145–64.
Auriacombe M, Affelou S, Lavignasse P, et al. Pregnancy, abortion and delivery in a cohort of heroin dependent patients treated with drug substitution (methadone and buprenorphine) in Aquitaine. Presse Med. 1999;28:177.
Auriacombe M, Fatseas M, Dubernet J, et al. French field experience with buprenorphine. Am J Addict. 2004;13(suppl 1):S17–S28.
Ballantyne JC, LaForge KS. Opioid dependence and addiction during opioid treatment of chronic pain. Pain 2007;129(3):235–55.
Bhuvaneswar CG, Chang G, Epstein LA, Theodore SA. Cocaine and opioid use during pregnancy: prevalence and management. Prim Care Companion J Clin Psychiatry. 2008;10(1):59–65.
Bickel WK, Slitzer ML, et al. A clinical trial of buprenorphine: Comparison with methadone in the detoxification of heroin addicts. Clin Pharmacol Ther. 1988;43:72–8.
Bonica JJ. Biology, pathophysiology, and treatment of acute pain. In: Lipton S, Miles J, editors. Persistent pain. Orlando, FL: Grune & Stratton; 1985. vol. 5. pp. 1–32.
Boot BP, McGregor IS, Hall W. MDMA (Ecstasy) neurotoxicity: assessing and communicating the risks. Lancet 2000;355:1818–21.
Brauer RB, Heidecke CD, Nathrath W, et al. Liver transplantation for the treatment of fulminant hepatic failure induced by the ingestion of ecstasy. Transpl Int. 1997;10:229–33.
Brookoff D. Abuse potential of various opioid medications. J Gen Intern Med. 1993;8:688–90.
Brust JC. Clinical, radiological, and pathological aspects of cerebrovascular disease associated with drug abuse. Stroke 1993;24:1129–33.
Carrera MR, Meijler MM, Janda KD. Cocaine pharmacology and current pharmacotherapies for its abuse. Bioorg Med Chem. 2004;12:5019–30.
Chang G, et al. Opioid tolerance and hyperalgesia. Med Clin North Am. 2007;91(2):199–211.
Christophersen AS. Amphetamine designer drugs: an overview and epidemiology. Toxicol Lett. 2000;112:127–31.
Cohen S. Cannabinoids for chronic pain. BMJ 2008 Jan;336:167–8.
Coluzzi F, Pappagallo M. Opioid therapy for chronic noncancer pain: Practice guidelines for initiation and maintenance of therapy. Minerva Anestesiol 2005;71(7–8):425–33.
Compton P, Athanasos P. Chronic pain, substance abuse and addiction. Nurs Clin North Am. 2003;38(3):525–37.
Compton WM, Volkow ND. Abuse of prescription drugs and the risk of addiction. Drug Alcohol Depend. 2006 Jun;83(suppl 1):S4–7.
Derlett RW, Rice P, Horowitz BZ, Lord RV. Amphetamine toxicity: experience with 127 cases. J Emergency Med. 1989;7:157–61.
Duburcq A, Charpak Y, et al. Two years follow-up of a heroin users cohort treated with high dosage buprenorphine. Results of the SPESUB study (pharmacoepidemiologic follow-up of general practice Subutex). Rev Epidemiol Sante Publique. 2000;48(4):363–73.
Eriksson M, Jonsson B, Zetterstrom R. Children of mothers abusing amphetamines: head circumference during infancy and psychosocial development until 14 years of age. Acta Paediatr. 2000;89:1474–8.
Feldman JA, Fish SS, Beshansky JR, et al. Acute cardiac ischemia in patients with cocaine associated complaints: results of a multicenter trial. Ann Emerg Med. 2000;36:469–76.
Fiege M, Wappler F, Weisshorn R, et al. Induction of malignant hyperthermia in susceptible swine by 3,4-methylenedioxymethamphetamine (“ecstasy”). Anesthesiology 2003;99:1132–6.
Fiellin DA, O’Connor PG. Clinical practice: office-based treatment of opioid-dependent patients. N Engl J Med. 2002;347:817–23.
Fischer G, Ortner R, Rohrmeister K, et al. Methadone versus buprenorphine in pregnant addicts: a double blind, double dummy comparison study. Addiction 2006;101:275–81.
Gammaitoni E, Gould H, Ahdieh T. Opana ER improves pain quality measures in opioid-experienced patients with chronic low back pain. J Pain 2007;8(4 supp1):S44.
Gatof D, Albert RK. Bilateral thumb burns leading to the diagnosis of crack lung. Chest 2002;121:289–91.
Giacomuzzi S, Kemmler G, Ertl M, Riemer Y. Opioid addicts at admission vs. slow-release oral morphine, methadone, and sublingual buprenorphine maintenance treatment participants. Subst Use Misuse 2006;41(2):223–44.
Gourlay DL, Heit HA, Almahrezi A. Universal precautions in pain medicine: A rationale approach to the treatment of chronic pain. Pain Med. 2005;6(2):107–12.
Garrido MJ, Troconiz IF. Methadone: a review of its pharmaco-kinetic/pharmacodynamic properties. J Pharmacol Toxicol Methods 1999;42:61–6.
Greydanus DE, Patel DR. Substance abuse in adolescents: a complex conundrum for the clinician. Pediatr Clin North Am. 2003;50:1179–223.
Hale ME, Dvergsten C, Gimbel J. Efficacy and safety of oxymorphone extended release in chronic low back pain: Results of a randomized, double-blind, placebo- and active-controlled phase III study. J Pain. 2005;6:21–8.
Heit HA. Addiction, physical dependence, and tolerance: precise definitions to help clinicians evaluate and treat chronic pain patients. J Pain Palliat Care Pharmacother. 2003;17(1):15–29.
Hernandez M, Birnbach D, Zundert A. Anesthetic management of the illicit-substance using patient. Curr Opin Anaesthesiol. 2005;18:315–24.
Hojsted J, Sjogren P. Addiction to opioids in chronic pain patients: A literature review. Eur J Pain. 2007;11(5):490–518.
Hsue PY, Salinas, CL, Bolger AF, et al. Acute aortic dissection related to crack cocaine. Circulation 2002;105:1592–95.
Hulse GK, Milne E, English DR, et al. Assessing the relationship between maternal opiate use and neonatal mortality. Addiction 1998;93:1033–42.
Jeffcoat AR, Perez-Reyes M, Hill JM, Sadler BM, Cook CE. Cocaine disposition in humans after intravenous injection, nasal insufflation (snorting), or smoking. Drug Metab Dispos. 1989 Mar–Apr;17(2):153–9.
Joranson DE, Ryan KM, Gilson AM, Dahl JL. Trends in medical use and abuse of opioid analgesics JAMA 2000;283(13):1710–4.
Kahila H. Saisto T, Kivitie-Kallio S, et al. A prospective study on buprenorphine use during pregnancy: effects on maternal and neonatal outcome. Acta Obstet Gyncol Scand. 2007;86:185–90.
Kain ZN, Barash PG. Anesthetic implications of drug abuse. ASA refresher course lectures. Ed: Alan Jay Schwartz vol 29.
Kain ZN, Rimar S, Barash PG. Cocaine abuse in the parturient and effects on the fetus and neonate. Anesth Analg. 1993;77:835–45.
Kashiwagi M, Arlettaz R, Lauper U, et al. Methadone maintenance program in a Swiss perinatal center, 1: management and outcome of 89 pregnancies. Acta Obstet Gynecol Scand. 2005;84:140–4.
Kasser CL, Geller A, Howell E, Wartenberg A. Principles of detoxification. In: Graham AW, Schultz, editors. Principles of addiction medicine. 2nd ed. Chevy Chase, MD: American Society of Addiction Medicine; 1998. pp. 423–30.
Kusche C. Managing drug withdrawal in the newborn infant. Semin Fetal Neonatal Med. 2007;12:127–33.
Luty J, Nikolau V, Beam J. Is opiate detoxification unsafe in pregnancy? J Subs Abuse Treat. 2003;24:363–7.
Manchikanti L, Cash KA, Damron KS, Manchukonda R, Pampati V, McManus CD. Controlled substance abuse and illicit drug use in chronic pain patients: An evaluation of multiple variables. Pain Phys. 2006;9:215–25.
Manchikanti L, Pampati V, et al. Prevalence of illicit drug use in patients without controlled substance abuse in interventional pain management. Pain Phys. 2003;6(2):173–8.
Mark TL, Woody GE, Juday T, et al. The economic costs of heroin addiction in the United States. Drug Alcohol Depend. 2001;61:195–206.
Marzuk PM, Tardiff K, Leon AC, et al. Ambient temperature and mortality form unintentional cocaine overdose. JAMA 1998;279:1795–800.
Matsumoto AK, Babul N, Ahdieh H. Oxymorphone extended-release tablets relieve moderate to severe pain and improve physical function in osteoarthritis: results of a randomized, double-blind, placebo- and active-controlled phase III trial. Pain Med. 2005;6:357–66.
McCarthy JJ, Leamon MH, Parr MS, et al. High dose methadone maintenance in pregnancy: maternal and neonatal outcomes. Am J Obstet Gyncol. 2005;193:606–10.
McIlwain H, Ahdieh H. Safety, tolerability, and effectiveness of oxymorphone extended release for moderate to severe osteoarthritis pain: a one-year study. Am J Ther. 2005;12: 106–12.
Mehanny SZ, Abdel-Rahman MS, Ahmed YY. Teratogenic effect of cocaine and diazepam in CF1 mice. Teratology 1991;43:11–7.
Merskey H, Bogduk N. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. 2nd ed. Seattle, WA: IASP Press; 1994.
Milroy CM. Ten years of “ecstasy”. J R Soc Med. 1999;9268–71.
Mouhaffel AH, Madu EC, Satmary WA, et al. Cardiovascular complications of cocaine. Chest 1995;107:1426–34.
Nestler EJ, Hyman SE, Malenka RC. Reinforcement and addictive disorders. In molecular neuropharmacology: a foundation for clinical neuroscience. New York, NY: McGraw-Hill; 2001.
Office of Applied Studies. Substance abuse and mental health services administration. The DAWN Report, January 2003.
Pappagallo M. The concept of pseudotolerance to opioids. J Pharm Care Pain Symp Control. 1998;6:95–8.
Passik SD, Kirsh KL. Managing pain in patients with aberrant drug-taking behaviors. J Support Oncol. 2005;3(1):83–6.
Passik SD, Portenoy RK, Ricketts PL. Substance abuse issues in cancer patients part 1: prevalence and diagnosis. Oncology 1998;12(4):517–21.
Passik SD, Portenoy RK. Substance Issues in palliative care. In: Berger A, et al, editors. Principles and practice of supportive oncology. Philadephia, PA: Lippincott-Raven; 1998. pp. 513–24.
Pastermark GW. The pharmacology of mu analgesics: from patients to genes. Neuroscientist 2001;7(3):220–31.
Perez-Reyes M, Di Guiseppi S, Ondrusek G, et al. Free-base cocaine smoking. Clin Pharmacol Ther. 1982;32:459–65.
Perry S. Heidrich G. Management of pain during debridement: a survey of U.S. burn units. Pain 1982;13:267.
Pitts W, Lange R, Cigarroa J, et al. Cocaine-induced myocardial ischemia and infarction: physiology, pathology, recognition, and management. Prog Cardiovasc Dis. 1997;40:65–76.
Porer K. Acute heroin overdose: update. Ann Intern Med. 1999;130:584–90.
Portenoy RK, Payne R. Acute and chronic pain, In: Lowinson J, Ruiz P, Millman RB, et al, editors. Substance abuse: a comprehensive textbook. 2nd ed. Baltimore, MD: Williams & Wilkins; 1992. pp. 691–721.
Portenoy RK, Savage SR. Clinical realities and economic considerations: special therapeutic issues in intrathecal therapy-tolerance and addiction. J Pain Symptom Manage. 2007;14(3):S27–S35.
Reneman L, Habraken JB, Mojoie CB, et al. MDMA (“ecstasy”) and its association with cerebrovascular accidents: preliminary findings. Am J Neuroradiol. 2000;21:1001–07.
Resnick RB. Food and drug administration approval of buprenorphine-naloxone for office treatment of addiction [letter]. Ann Intern Med. 2003;138:360.
Rich BA. A Chronic pain patient’s perspective on opioid tolerance. J Pain Palliat Care Pharmacother 2007;21(1):43.
Rinaldi RC, Steindler EM, Wilford BB, Goodwin D. Clarification and standardization of substance abuse terminology. JAMA 1988;259:555–7.
Rittoo DB, Rittoo D. Complications of “ecstasy” misuse. Lancet 1992;340:725–6.
Rosenblatt AB, Mekhail NA. Management of pain in addicted/illicit and legal substance abusing patient. Pain Pract. 2005;5(1):2–10.
Roundaville BJ, Kosten TR. Treatment for opioid dependence: quality and access. JAMA 2000;283:1337–9.
Strain EC, Stitzer ML, et al. Methadone and treatment outcome. Drug Alcohol Depend. 1993;33(2): 105–17.
Savage SR. Assessment of addiction in pain-treatment settings. Clin J Pain. 2002;18(4 suppl):S28–S38.
Schnoll SH, Weaver MF. Addiction and pain. Am J Addict. 2003;12(suppl 2):S27–35.
Shanti CM, Lucas CE. Cocaine and the critical care challenge. Crit Care Med. 2003;31: 1851–9.
Shulgin A. The background and chemistry of MDMA. J Psychoact Drugs 1986;18:291–304.
Siddall PJ, Cousins MJ. Introduction to pain mechanisms. Implications for neural blockade. In: Cousins MJ, Bridenbaugh PO, editors. Neural blockade in clinical anesthesia and management of pain. 3rd ed. Philadelphia, PA: Lippincot-Raven; 1998. pp. 692–3.
Sinatra RS. Acute pain management and acute pain services. In: Cousins MJ, Bridenbaugh PO, editors. Neural blockade in clinical anesthesia and management of pain. 3rd ed. Philadelphia, PA: Lippincot-Raven; 1998. p. 802.
Sloan P, Slatkin N, Ahdieh H. Effectiveness and safety of oral extended-release oxymorphone for the treatment of cancer pain: a pilot study. Support Care Cancer 2005;13:57–65.
Smith MY, Woody G. Nonmedical use and abuse of scheduled medications prescribed for pain, pain-related symptoms, and psychiatric disorders: patterns, user characteristics, and management options. Curr Psychiatry Rep. 2005;7(5):337–43.
Substance Abuse and Mental Health Services Administration office of Applied Studies. National Survey on Drug Use and Health, Results 2007. Washington DC: US Department of Health and Human Services;2007.
US Department of Health Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Results from the 2005 National Survey on Drug Use and Health: National Findings. Rockville, Md: US Dept Health Human Services; 2006.
Weaver MF, Schnoll SH. Opioid treatment of chronic pain in patients with addiction. J Pain Palliat Care Pharmacother 2002;16(3):5–26.
Weissman DE, Haddox JD. Opioid pseudoaddiction—an iatrogenic syndrome. Pain 1989;36(3):363–6.
Wolff K, Boys A, Rostami-Hodjegan A, et al. Changes to methadone clearance during pregnancy. Eur J Clin Pharmacol. 2005;61:763–8.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Dabu-Bondoc, S., Zhang, R., Vadivelu, N. (2011). Managing Pain in the Addicted Patient. In: Vadivelu, N., Urman, R., Hines, R. (eds) Essentials of Pain Management. Springer, New York, NY. https://doi.org/10.1007/978-0-387-87579-8_31
Download citation
DOI: https://doi.org/10.1007/978-0-387-87579-8_31
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-0-387-87578-1
Online ISBN: 978-0-387-87579-8
eBook Packages: MedicineMedicine (R0)