Smoking and Problematic Use of Prescription Opioid Medication Among Pain Patients

Lara K. Dhingra, PhD

Attending Psychologist
Department of Pain Medicine and Palliative Care
Beth Israel Medical Center
Assistant Professor of Neurology and Psychiatry and Behavioral Sciences
Albert Einstein College of Medicine
New York, New York
Many screening and monitoring tools – including the Opioid Risk Tool (ORT) and the Current Opioid Misuse Measure (COMM) – exist to assess and monitor the risk that a pain patient will engage in aberrant or problematic use of his/her pain medication. Along with questions regarding personal and family history of psychiatric diagnoses and substance abuse, current cigarette use also emerges as a factor associated with an increased risk of medication abuse.

The link between current smoking and problematic opioid medication use is well documented. The relationship between the two is complex, however. One theory is that depression is an underlying link between smoking and aberrant behaviors– smoking is strongly comorbid with depressive disorders. Pseudoaddiction has also been posited as an explanation – nicotine may effect opioid metabolism, diminishing its analgesic efficacy. The construct of chemical coping – the tendency of some individuals to “self medicate” with alcohol, medication, or cigarettes, in an effort to releieve distress and manage stress – may also account for some of the comorbidity between cigarette smoking and aberrant medication taking behaviors. While further research is needed on why smoking and aberrant medication taking are correlated, current evidence demonstrates a clear correlation. Clinicians should ask about their patients’ use of cigarettes.

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