Markers of abuse liability of short- vs long-acting opioids in chronic pain patients: a randomized cross-over trial

Pharmacol Biochem Behav. 2009 Nov;94(1):98-107. doi: 10.1016/j.pbb.2009.07.014. Epub 2009 Aug 4.

Abstract

Background: Abuse liability is thought to possibly be lower in long- than in short-acting opioids because lower peak serum levels may be less likely to induce psychoactive effects.

Methods: We compared patient responses to extended-release morphine, hydrocodone plus acetaminophen, and placebo in a randomized, double-blind crossover study using markers of abuse liability. Patients indicated their craving for drugs on 5 visual analog scales (VASs), completed the Addiction Research Center Inventory, and underwent cue reactivity testing. To perform the latter, subjects watched a video intended to produce a positive or a negative affect, after which a vial of medication was or was not presented (the cue) and then indicated their craving for drugs on 5 different VASs (the reactivity).

Results: Differences in Addiction Research Inventory scores were statistically significant but clinically unimportant. Neuropsychological test results were mixed and unrelated to the medications studied. Cue reactivity did not differ among conditions but was uniformly high.

Conclusions: Using several markers of abuse liability, long-acting opioids do not have lower abuse potential than do short-acting opioids or placebo. Although cue reactivity did not differ among the conditions, uniformly high results in these patients suggest that it may have some value as a component of abuse liability testing.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / therapeutic use*
  • Behavior, Addictive / diagnosis
  • Chronic Disease / drug therapy
  • Conscious Sedation
  • Cross-Over Studies
  • Cues
  • Double-Blind Method
  • Female
  • Humans
  • Hydrocodone / therapeutic use
  • Male
  • Middle Aged
  • Morphine / therapeutic use
  • Opioid-Related Disorders / diagnosis*
  • Pain / drug therapy*
  • Self Administration
  • Stress, Physiological
  • Substance Abuse Detection / methods*
  • Surveys and Questionnaires
  • Time Factors

Substances

  • Analgesics, Opioid
  • Hydrocodone
  • Morphine