Substance Use
Chronic pain, PTSD, smoking and opioid misuse: An interaction analysis Ananya Dhanya* Ananya Dhanya Dhanya Dhanya Dhanya New York City Department of Health & Mental Hygiene
Introduction: This study examined whether chronic pain was associated with opioid misuse and modified by smoking or posttraumatic stress disorder (PTSD) or both, among 9/11-exposed individuals.
Methods: Longitudinal survey data was obtained from 23,714 World Trade Center Health Registry enrollees; 4.18% reported opioid misuse in 2020-21. Opioid misuse was defined as taking more than the recommended dose or using opioids not prescribed in the last 12 months. The exposure was self-reported physician-diagnosed post-9/11 chronic pain. Potential effect modifiers were symptoms of probable 9/11-related PTSD (current, former, never) and cigarette or e-cigarette smoking history (current, former, never). Multivariable logistic regression estimated associations of chronic pain with opioid misuse. Two-way interaction between chronic pain and each modifier was assessed on multiplicative (interaction terms) and additive [Relative Excess Risk due to Interaction (RERI)] scales. Three-way interaction between chronic pain, PTSD, and smoking status was also assessed.
Results: Chronic pain was independently associated with opioid misuse [adjusted OR (aOR)=2.10, 95% CI: 1.79-2.45]. While chronic pain, current PTSD, and current smoking were each independently associated with opioid misuse, evidence of effect modification on the additive scale was not observed (RERI=1.69, 95% CI: -1.78, 5.16). Similarly, though stratified analyses showed stronger associations of opioid misuse with chronic pain among current smokers [aOR=4.23, 95% CI: 3.18-5.63], those with current PTSD [aOR=3.97, 95% CI: 3.11-5.08], and among enrollees with chronic pain, current PTSD, and current smoking [aOR=8.55, 95% CI: 5.54-13.18], two (Psmoking*pain=0.06; PPTSD*pain=0.12)- and three (Psmoking*PTSD*pain=0.31)-way interaction terms were not significant.
Conclusion: Pathways linking chronic pain to opioid use are complex and may require integrated approaches to care that address mental health and behavioral factors.
