Background & Aims

Alcohol use has garnered increasing empirical and clinical attention in the context of chronic pain management in older adults [19; 20; 23]. Pain is associated with greater alcohol use/misuse in this population [2; 3; 8; 10; 13]. Drinking alcohol can lead to poorer pain- and health-related outcomes [9; 28]. Moreover, despite known risks of drinking while taking opioid analgesics [11], initial work suggests that older adults who are prescribed opioids frequently misuse alcohol [6; 19]. To identify subgroups of older adults with chronic pain who are at increased risk for alcohol use/misuse and subsequent health consequences, additional work is needed to examine associations between prescription opioid use and alcohol use in this population. Therefore, the goal of these analyses was to test whether older adults with chronic pain who use (vs. do not use) prescription opioid analgesics are more likely to engage in alcohol use/misuse.

Methods

A sample of 1,296 older adults (age ?65) with chronic pain were recruited from the AmeriSpeak® Panel – a probability-based panel designed to be representative of the United States population. Participants were asked if they had used prescription opioid pain relievers in the past three months and if they ever drink any alcoholic beverages (e.g., beer, wine, or liquor). Those who reported alcohol consumption were asked to complete the CAGE screener [4], which is a 4-item test for alcohol misuse that asks: 1) Have you ever felt that you ought to Cut down on your drinking? 2) Have people Annoyed you by criticizing your drinking? 3) Have you ever felt bad or Guilty about your drinking? 4) Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye-opener)? Statistical analyses were conducted using SAS 9.4. All analyses incorporated survey design weights.

Results

Overall, 59.1% of older adults with chronic pain reported alcohol consumption (95% CI: 55.7-62.5). Specifically, 54.7% (95% CI: 48.2-61.1) of those who used prescription opioids in the past three months consumed alcohol, compared to 61.0% (95% CI: 57.0-64.9) of those who did not use prescription opioids (p = .10). Among older adults with chronic pain who reported alcohol consumption, 13.8% (95% CI: 10.6-17.0) scored above the CAGE cutoff for alcohol misuse. Those who used prescription opioids were twice as likely to engage in alcohol misuse (20.2%, 95% CI: 12.0-28.4) than those who did not use prescription opioids (11.4%, 95% CI: 8.4-14.5; OR=2.0, 95% CI: 1.1-3.5).

Conclusions

Alcohol use is common among older adults with chronic pain, including those who use prescription opioid analgesics. Moreover, those who use prescription opioid analgesics are twice as likely to engage in alcohol misuse than those who do not use prescription opioid analgesics. This finding is alarming given that alcohol-opioid interactions may increase the risk of falls, altered cognitive function, accidents/injuries, overdose, and death [1; 25; 27]. In addition, alcohol-opioid cross-tolerance may interfere with pain management by reducing the analgesic effects of opioid analgesics [9]. These findings underscore the need to assess for and mitigate alcohol use/misuse among older adults with chronic pain – especially among those who use opioid analgesics and thus may be at greater risk for dangerous health effects.

References

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Presenting Author

Lisa R. LaRowe

Poster Authors

Lisa LaRowe

PhD

Massachusetts General Hospital

Lead Author

Natalie Pineda

Lead Author

Chris Miaskowski RN

PhD

University of California San Francisco

Lead Author

Francis Keefe

Duke University

Lead Author

Christine Ritchie

Massachusetts General Hospital

Lead Author

Topics

  • Pain in Special Populations: Elderly