The Interaction of Alcohol Use and Cannabis Use Problems in Relation to Opioid Misuse Among Adults with Chronic Pain



The opioid epidemic is a significant public health crisis and prescription opioids are often used to manage chronic pain, despite questionable long-term efficacy. Furthermore, co-substance (mis)use is also common among individuals with chronic pain who use opioids. Alcohol has been consistently used to manage chronic pain, partly due to its acute analgesic properties. Cannabis has also recently garnered attention in the context of pain management, though research examining its efficacy for pain has produced mixed results. Nevertheless, there is accumulating evidence that concurrent substance co-use is positively associated with use and misuse of additional substances, particularly among individuals with chronic pain. Thus, the goal of this study was to examine the main and interactive effects of alcohol use problems and cannabis use problems in relation to opioid misuse among adults with chronic pain who use opioids.


The current sample was comprised of 440 adults with chronic pain using prescription opioids. Substance use problems were assessed using the ASSIST, Current Opioid Misuse Measure, and the Severity of Dependence Scale. Moderated regressions using the PROCESS macro were utilized.


Results indicated that alcohol use problems and cannabis use problems each uniquely related to opioid dependence severity and opioid misuse. The interaction of alcohol and cannabis use problems was uniquely related to only opioid misuse, whereby alcohol use was most strongly associated to opioid misuse among those with higher levels of cannabis use problems.


Collectively, these findings suggest there may be utility in assessing and treating alcohol and cannabis use problems among persons with chronic pain who are using opioids for pain management.

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The current study was funded by the State of Texas funding.

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Corresponding author

Correspondence to Michael J. Zvolensky.

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The study protocol was approved by the Institutional Review Board at the University of Houston and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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The authors declare that they have no conflict of interest.

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Rogers, A.H., Shepherd, J.M., Paulus, D.J. et al. The Interaction of Alcohol Use and Cannabis Use Problems in Relation to Opioid Misuse Among Adults with Chronic Pain. Int.J. Behav. Med. 26, 569–575 (2019).

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