PAIN TOLERANCE AND ANALGESIC RESPONSE IN OPIATE ADDICTS

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NIDA's recently released (6/94) Program Announcement (#94-070) on Prescription Drug Use, Abuse and Diversion reflects a growing appreciation among clinicians and researchers in both the areas of pain and addiction of the complexities involved in prescribing opioid analgesics, which have clear therapeutic indications, to patients with a known history of drug abuse. The proposed RO3 application, with a relatively new researcher serving as principal investigator, describes a necessary first step to estimating the risk of analgesic abuse by opiate addicts in pain, and developing appropriate practice and regulatory guidelines for analgesic prescription to known drug abusers. Pain tolerance and analgesic response will be described in two samples of opiate-maintained drug abusers (54 methadone-maintained and 54 buprenorphine-maintained male and female subjects) in comparison to a sample (n=54) of non-dependent controls matched on race and gender. Pain tolerance is operationalized as tolerance to a standard cold-pressor trial. Analgesic response is operationalized as change in cold-pressor trial tolerance following double-blind challenges to an opioid analgesic (Dilaudid, 3 mg., PO), a nonsteroidal anti-inflammatory analgesic (Toradol, 10 mg., PO), and placebo, using a Latin Square design. The differential effects of opiate maintenance agent and analgesic agent on pain tolerance will be the primary subjects of analyses. It is anticipated that the findings from the proposed study will provide preliminary information on analgesic need and response in opiate- maintained drug abusers, and lead to the subsequent development of larger evaluations of appropriate analgesic prescription to individuals with a history of drug abuse. Studies of pain tolerance and analgesic response in samples of opiate addicts and other drug abusers, not in treatment, and experiencing acute or chronic pain in clinical settings, are logical extensions of the proposed work to increase the generalizability and utility of the findings in practice and regulatory contexts.