Back Pain Is Linked to Increased Risk of Illicit Drug Use

Individuals with chronic low back pain (cLBP) are more likely to use illicit drugs than those without back pain, according to a recent study presented at PainWeek 2016.

Although opioids are often prescribed for patients with cLBP, opioid prescribing raises many concerns regarding addiction, misuse, and accidental overdose. Previous studies have suggested a link between patients with a history of illicit drug use and prescription opioid misuse. However, few studies have examined this link in the American population.

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To conduct their study, the researchers analyzed data from 5103 individuals aged 20 to 69 years who responded to a back pain questionnaire in the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2010.

Individuals were classified as having cLBP if they reported current pain in the area between the lower posterior margin of the ribcage and the horizontal gluteal fold at the time of evaluation with a history of pain lasting almost every day for at least 3 months (n=700).

After analyzing the data, the researchers found that individuals with cLBP were more likely to use marijuana, cocaine, heroin, and methamphetamine than those without cLBP.

Within the previous 30 days, 14% of people with cLBP had used illicit drugs compared with 9% of those without pain.

Overall, rates of lifetime use for people with pain vs no pain, respectively, were 47% vs 42% for marijuana, 22% vs 14% for cocaine, 9% vs 5% for methamphetamine, and 5% vs 2% for heroin.

In addition, those with cLBP who reported lifetime illicit drug use were more likely to have an active prescription for opioid analgesics than those without illicit drug use history: 22.5% vs 15.3%.

“Our study offers insights into an important public health problem of drug abuse in the cLBP population, and has the advantage of using a nationally representative sample of community-dwelling adults,” the researchers concluded.

“Further evaluation of illicit drug use as a predictor in longitudinal studies of cLBP will facilitate a deeper understanding of the relationships between pain, illicit substance use, and prescription opioid administration, and assist in the design of safe and sustainable interventions for patients with chronic pain.”

—Amanda Balbi


Shmagel A, Krebs E, Ensrud K, Foley R. Illicit substance use in US adults with chronic low back pain. Spine. 2016;41(17):1372-1377. Accessed September 9, 2016.