Cognitive, Behavioral and Aging Effects of Opioids in Alcohol Users

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 DESCRIPTION (provided by applicant): An Institute of Medicine (IOM) report indicates that millions of Americans suffer from chronic pain conditions and that annual health care costs related to chronic pain are estimated at over half a trillion dollars. The prevalence of pain is greatest amongst older adults and is often associated with significant physical and psychosocial disability. Estimates of the prevalence of persistent pain problems among community-dwelling elderly persons range from 30-80%. Increasing evidence suggests an association between chronic pain and alcohol use disorder that is of great concern in older adults. Chronic unhealthy alcohol use has the potential of altering the subjective experience of pain and response to pain medications, which could complicate or compromise the effective clinical management of pain. In particular, unhealthy alcohol use in older adults may exacerbate debilitating side effects from opioid use, such as impaired cognition, diminished coordination and balance, and enhanced risk for falls that can threaten independent living. In addition, unhealthy alcohol use could increase the abuse potential of pain medications. However, the influence of unhealthy alcohol use on the pharmacokinetics and pharmacodynamics of opioid analgesics has not been studied in the elderly population. Our overall goal is to investigate the impact of aging and alcohol use on response to opioid analgesics in a controlled human laboratory study. We will compare pain relief as well as subjective, cognitive, and reinforcing side effects after an acute oral test doseof oxycodone in the following groups of subjects with mild to moderate recurring pain: 1) older adults (> 65 yrs) with unhealthy levels of alcohol use; 2) older adults with healthy levels of alcohol use; 3) middle-aged adults (35-55 yrs) with unhealthy levels of alcohol use; 4) middle-aged adults with healthy levels of alcohol use. "PA-13-058 Pain in Aging" calls for studies that examine the mechanisms and processes by which factors impact the experience and treatment of pain in older adults, including the interaction of alcohol use and pain. The proposed controlled laboratory study is innovative in that it may provide the first demonstration in humans of a highly plausible, but heretofore unproven interaction between chronic alcohol use and opioid response in the clinical context of therapeutic use and abuse liability of opioid analgesics. If proven true it would likely lead to in-depth studies on the confounding effects of excessive alcohol consumption on the efficacy, tolerability and safety of long-term opioid therapy in pain patients.