Alcohol and Opioid Use, Co-Use, and Chronic Pain in the Context of the Opioid Epidemic: A Critical Review

Abstract

The dramatic increase in opioid misuse, opioid use disorder (OUD), and opioid-related overdose deaths in the United States has led to public outcry, policy statements, and funding initiatives. Meanwhile, alcohol misuse and alcohol use disorder (AUD) are a highly prevalent public health problem associated with considerable individual and societal costs. This study provides a critical review of alcohol and opioid misuse, including issues of prevalence, morbidity, and societal costs. We also review research on interactions between alcohol and opioid use, the influence of opioids and alcohol on AUD and OUD treatment outcomes, respectively, the role of pain in the co-use of alcohol and opioids, and treatment of comorbid OUD and AUD. Heavy drinking, opioid misuse, and chronic pain individually represent significant public health problems. Few studies have examined co-use of alcohol and opioids, but available data suggest that co-use is common and likely contributes to opioid overdose-related morbidity and mortality. Co-use of opioids and alcohol is related to worse outcomes in treatment for either substance. Finally, chronic pain frequently co-occurs with use (and co-use) of alcohol and opioids. Opioid use and alcohol use are also likely to complicate the treatment of chronic pain. Research on the interactions between alcohol and opioids, as well as treatment of the comorbid disorders is lacking. Currently, most alcohol research excludes patients with OUD and there is lack of measurement in both AUD and OUD research in relation to pain-related functioning. Research in those with chronic pain often assesses opioid use, but rarely assesses alcohol use or AUD. New research to examine the nexus of alcohol, opioids, and pain, as well as their treatment, is critically needed.

Keywords: Alcohol Misuse; Alcohol Use Disorder; Chronic Pain; Opioid Misuse; Opioid Use Disorder.

Copyright © 2018 by the Research Society on Alcoholism.

Figures

Figure 1

Prevalence of alcohol use disorder (AUD) and prescription opioid use disorder (OUD) in the 2001–2002 and 2012–2013 National Epidemiological Survey on Alcohol and Related Conditions (NESARC; Grant et al., 2017; Saha et al., 2016) and 2002 and 2012 National Survey on Drug Use and Health (NSDUH; Han et al., 2017), and proportion of individuals seeking treatment primarily for prescription opioids or alcohol in the 2002 and 2012 Treatment Episode Dataset (TEDS; SAMHSA, 2014).