Objectives

The prescription of strong opioid analgesics for chronic non-cancer pain (CNCP) is described as controversial and can result in misidentification of patients as drug abusers or individuals with an addiction. This study compared the effects of opioid drugs on CNCP patients and "street" users.

Subjects/setting

The groups comprised 36 CNCP patients attending a pain clinic 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 escalation, cessation of use, compulsion to use, effects on career, relationships and activities, experience of "highs," and problems due to intoxication. To assess physiological dependence, subjects answered questions on specific effects e.g. stomach pains, nausea/vomiting, cramps/aches, etc.). Efficacy was assessed in CNCP patients by determining analgesia and physical function.

Results

CNCP patients started therapy in the low dose range for oral morphine (</=60 mg/day) and most (83%) did not move into a higher dose range once adequate levels of analgesia were attained. Street users started smoking heroin intermittently, before daily use. Most escalated their dose by increasing the amount used and by switching from smoking to injecting. Unlike CNCP patients, street users demonstrated patterns of compulsive drug use, social problems and intoxication. Only 3 / 31 (9.5%) pain patients that discontinued opioid therapy reported withdrawal symptoms on abstaining from the drug compared to 35 (89.5%) of street users.

Conclusion

Findings suggest that CNCP patients prescribed strong opioid analgesics derive more benefit than harm.