If you have chronic low back pain (cLBP), you are more likely to use illicit drugs like marijuana, cocaine, heroin and methamphetamine than those who don’t have back pain, says a study in the medical journal, Spine.
The study also found that those with chronic low back pain and who have a history of illicit drug use are more likely to have a current prescription for opioids, says the lead author of the study, Dr. Anna Shmagel of University of Minnesota, and colleagues. They noted that it’s not clear which direction the association runs, but the patterns of illicit drug use may have implications for doctors deciding about prescribing opioids for patients with low back pain.
They study analyzed survey responses from over 5,000 adults (US citizens aged 20 to 69) from a nationally representative health study (the 2009-2010 National Health and Nutrition Examination Survey, or NHANES).
Nearly 13% of respondents met the study definition of cLBP – low back pain that persists for three months or longer. The confidential survey also asked participants about their use of marijuana, cocaine, heroin, and methamphetamine.
The results suggested that back pain was linked to higher rates of illicit drug use. About 49% of adults with cLBP said they had used illicit drugs, compared to 43% of those without cLBP. Rates of current illicit drug use (within the past 30 days) were also higher in the cLBP group: 14% versus 9%.
All four drugs in the survey were more commonly used by respondents with cLBP. Rates of lifetime use were about 46.5% versus 42% for marijuana, 22% versus 14% for cocaine, 9% versus 5% for methamphetamine, and 5% versus 2% for heroin. After adjustment for other factors, participants with cLBP were more than twice as likely to report methamphetamine and heroin use.
The results also suggested a link between illicit drugs and prescription opioids among patients with cLBP. Subjects who had used illicit drugs were more likely to have an active prescription for opioid analgesics – about 22% versus 15%. Current illicit drug users were also more likely to have an opioid prescription, although that difference was not statistically significant.
The nationwide data show that people with cLBP have higher rates of illicit drug use, and those with a past history of illicit drug use are more likely to be current users of opioid analgesics.
The researchers note some important limitations of their study, including a lack of data on whether illicit drug use occurred before or after cLBP. They also suggest that the true scope of the problem may be even greater, since NHANES excludes some groups at high risk of illicit drug use.
Pending further research, doctors may want to consider these associations when evaluating pain relief options for patients with cLBP, Dr. Shmagel and coauthors believe.