Co-morbid pain and psychopathology in males and females admitted to treatment for opioid analgesic abuse

Theodore J. Cicero, Michael Lynskey, Alexandre Todorov, James A. Inciardi, Hilary L. Surratt

Research output: Contribution to journalArticlepeer-review

97 Scopus citations


The purpose of this study was to identify co-morbidity in a national sample (N = 1408) of males and females entering treatment for opioid abuse. Our sample was primarily white, lived in small urban, suburban or rural locations (80%), and was well-educated. Chronic pain was a symptomatic feature in over 60% of all subjects. Furthermore, 79% of male and 85% of female prescription opioid abusers indicated that their first exposure to an opioid was a legitimate prescription for pain which subsequently led 60-70% to misuse to get high. Our data also indicate that the use of prescription opioids to get high represents the end stage on a continuum of substance abuse, beginning at a very early age. The age of first alcohol use, getting drunk, smoking, use of marijuana, stimulants and other non-opioid prescription or illicit drugs occurred very early (13-19) in prescription opioid misusers/abusers, whose first use of opioids did not occur, on average, until age 22. Finally, most of the sample had sought treatment 3 or more times for substance abuse prior to the treatment admission in which the survey was completed. Physical and mental health were very poor in both male and female prescription opioid abusers, but females were more ill and dysfunctional than males in all physical and particularly emotional domains. Our results suggest that a small number of "at risk" opioid naive pain patients, who might abuse their therapeutically appropriate opioid analgesics, can be identified by assessing pre- and co-morbid substance abuse and significant psychopathology.

Original languageEnglish
Pages (from-to)127-135
Number of pages9
Issue number1
StatePublished - Sep 30 2008

Bibliographical note

Funding Information:
Supported in part by NIH Grant (DA020791). Although Drs. Cicero, Inciardi and Surratt serve as consultants to a number of pharmaceutical firms that market opioid analgesics, there is no overlap at all in terms of areas of consultation and this research nor was any funding provided by a pharmaceutical firm. Theodore J. Cicero had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.


  • Co-morbid
  • Misusers/abusers
  • Pain
  • Psychopathology
  • Substance use
  • TEDS

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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