Link between alcohol history and opioid misuse will earn closer examination

The possible role of alcohol use disorders in exacerbating risk of problems with opioid use has been a somewhat hidden aspect of the opioid crisis. New research that is being funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) will seek to get a better handle on the probability that alcohol use problems can precipitate opioid misuse in some groups.

Kenneth Leonard, PhD, co-investigator and director of the University at Buffalo's Clinical and Research Institute on Addictions, tells Addiction Professional that compelling data linking opioid and benzodiazepine problems with alcohol use call for a closer examination of these associations. With around one in five opioid-related deaths and a similar proportion of benzodiazepine-related deaths also involving alcohol, a key question to be explored is, “Why might some people with alcohol use disorders be likely to have further problems with opiates or benzos?” says Leonard.

The NIAAA-funded study, with initial funding for two years and the likelihood of three additional years of support, will seek first to quantify the extent of the problem of alcohol use disorders progressing to a pain diagnosis followed by prescription and misuse of opioids. Leonard says the research team then will explore a number of features from patients' alcohol treatment records to identify possible predictors of opioid misuse.

The research will help determine whether a percentage probability can be assigned for opioid misuse in the alcohol use disorder population, based on certain factors, Leonard says.

Integrating treatment records

The study will involve a records analysis of state Medicaid beneficiaries in New York. Researchers will seek to merge treatment records from Medicaid and the state Office of Alcoholism and Substance Abuse Services (OASAS), in an effort that could help make the case for why patient records should be more closely integrated in general.

“When you or I go to our physician, we're asked about [current] drinking,” Leonard says. “But they never ask about my [drinking] history.” This research will be designed to shed light on whether alcohol use history should become a factor in prescribers' decision on whether to recommend opioids to a patient, he says.

Factors around the link

Leonard cites several factors among those that can contribute to eventual opioid use problems among individuals with an alcohol use history:

• People with alcohol use disorders might experience events that can cause pain, such as falls or fights.

• Alcohol use can exacerbate certain conditions, such as post-surgical complications.

• Persons with problematic alcohol use might be less likely to follow through on treatment for physical illnesses, thus increasing the risk of suffering pain.

• Alcohol's analgesic properties could result in users' developing tolerance to these effects over time.

Leonard says the research is likely to point to factors such as family history and age of first use as being related to the eventual development of opioid use problems. “These are obvious, but we don't know how strong they will be,” he says.