Opioid drugs: A comparative survey of therapeutic and "street" use

Objectives. The prescription of strong opioid analgesics for chronic non-ca ncer pain (CNCP) is described as controversial and can result in misidentif ication of patients as drug abusers or individuals with an addiction. This study compared the effects of opioid drugs on CNCP patients and "street" us ers. Subjects/Setting. The groups comprised 36 CNCP patients attending a pain cl inic and 39 street users, recruited on London streets. Design. CNCP patients were interviewed in a pain clinic and street users in a street setting. A questionnaire was used to assess drug craving, dose es calation, cessation of use, compulsion to use, effects on career, relations hips and activities, experience of "highs," and problems due to intoxicatio n. To assess physiological dependence, subjects answered questions on speci fic effects (e.g. stomach pains, nausea/vomiting, cramps/aches, etc.). Effi cacy was assessed in CNCP patients by determining analgesia and physical fu nction. Results. CNCP patients started therapy in the low dose range for oral morph ine (less than or equal to 60 mg/day) and most (83%) did not move into a hi gher dose range once adequate levels of analgesia were attained. Street use rs started smoking heroin intermittently, before daily use. Most escalated their dose by increasing the amount used and by switching from smoking to i njecting. Unlike CNCP patients, street users demonstrated patterns of compu lsive drug use, social problems and intoxication. Only 3/31 (9.5%) pain pat ients that discontinued opioid therapy reported withdrawal symptoms on abst aining from the drug compared to 35 (89.5%) of street users. Conclusion. Findings suggest that CNCP patients prescribed strong opioid an algesics derive more benefit than harm.