Pain Medication Prescriptions and Misuse Following Treatment for Alcohol Use Disorders

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Abstract There are critical links between alcohol use disorder (AUD) and pain that have been largely ignored until recently. For example, individuals with alcohol dependence often experience physical injuries from accidents and violence that have a lasting physical impact. Chronic alcohol use can also lead to physical conditions that produce significant pain. Similarly, AUDs can also lead to poor adherence to medical regimens for diseases which can result in exacerbation in pain. Finally, given that common neural circuits are impacted by chronic pain and by alcohol dependence, alcohol dependence may lead to heightened feelings of pain, and that such pain may lead to alcohol use for its analgesic properties. Given these linkages between AUDs and chronic pain, it is not surprising to find significant proportions of individuals with AUD report that they experience significant pain and are in treatment for chronic pain. The presence of chronic pain among individuals with AUD, combined with the chronic, relapsing nature of alcohol use disorders raises the possibility that individuals with an alcohol use disorder may seek treatment for chronic pain, receive opioid and/or benzodiazepine prescriptions for pain, and be at risk for morbidity and mortality associated with using these medications, particularly in conjunction with excessive alcohol use. This study proposes to integrate records from the Client Data System of the New York State Office of Alcoholism and Substance Abuse Services (OASAS) patient records with New York State Medicaid records. We plan to identify approximately 214,000 Medicaid patients with a first contact with the OASAS treatment system from 2006-2014 and merge these treatment records with their Medicaid claims records from their initial treatment contact through 2015. In addition, we will draw a sample three times as large of matched individuals from the Medicaid claims to serve as a comparison sample. Hypotheses will address the extent to which individuals with a history of treatment for alcohol problems are at increased risk for receiving prescriptions for opioids and benzodiazepine for pain and whether this is because of an increased risk of pain diagnoses, or whether this risk remains after controlling for diagnoses. We will also determine if alcohol treatment patients are at further risk for higher doses, longer durations, and misuse/overdose from these substances, and whether pain diagnoses account for this risk. Moreover, the integration of these datasets will allow us to identify factors in the existing treatment records that would identify individuals most at risk for the excessive use and misuse of these medications. These findings will have important clinical implications for the management of patients in primary care with an unrecognized history of an alcohol use disorder and policy implications with respect to medical access to alcohol treatment records.