Chronic non-cancer pain and six-month follow-up outcomes among community-based opiate addiction treatment clients on methadone

Individuals who seek medication-assisted treatment for opiate addiction are generally prescribed methadone along with behavioral counseling at a licensed opiate treatment program (OTP). For OTP clients who also have chronic non-cancer pain (CNCP), the disease of addiction is treated, but the disease of CNCP may not be addressed. Though connecting opioid dependence and CNCP may seem obvious since opioids produce both analgesia and euphoria, limited data is available on their co-occurrence and the impact on treatment outcomes. This study hypothesized the presence of CNCP would be related to poor 6-month follow-up outcomes among a sample of individuals taking methadone as part of medication assisted treatment at an OTP. Analyses were compared 115 individuals with CNCP to 470 cases without CNCP, all of whom completed a structured baseline interview for the Kentucky Opiate Replacement Treatment Outcome Study between March 2007 and December 2010 and a matching follow-up interview. ANOVA results found no differences between the groups on number of arrests at follow-up. The only substance use difference was that CNCP cases reported a greater average number of past 30 day use of non-prescribed methadone at follow-up (.92) compared to non-CNCP cases [.17; F (1)=10.005, p<.01]. Crosstab analyses found a lower percentage of CNCP clients were employed at follow-up compared to non-CNCP clients (58.2% vs. 71.5%, p<.01). Differences were also found in mental health for the two groups with more CNCP cases than non-CNCP cases reporting depression (22.0% vs. 13.3%; p<.05) or anxiety (39.6% vs. 23.6%; p<.01) at follow-up. For patients with CNCP, co-occurring disorders would certainly counter the recovery efforts of MAT. Addressing co-occurring issues like pain and/or mental health problems will be important for MAT programs to successfully help patients learn to manage their health conditions and maintain sobriety.