Effects of cold pressor pain on the abuse liability of intranasal oxycodone in male and female prescription opioid abusers

Background: Approximately 1.9 million persons in the U.S. have prescription opioid use disorders often with concomitant bodily pain, but systematic data on the impact of pain on abuse liability of opioids is lacking. The purpose of this study was to determine whether pain alters the intranasal abuse liability of oxycodone, a commonly prescribed and abused analgesic, in males and females. Methods: Sporadic prescription opioid abusers (10 females, 10 males) participated in this mixed (between and within-subject), randomized inpatient study. Experimental sessions (n= 6) tested intranasal placebo, oxycodone 15 or 30. mg/70. kg during cold pressor testing (CPT) and a warm water control. Observer- and subject-rated drug effect measures, analgesia, physiologic and cognitive effects were assessed. Results: The CPT significantly increased blood pressure, heart rate, pain, stress, and " opiate desire" compared to the no-pain control but did not alter opioid liking, high or street value. Intranasal oxycodone produced effects within 10. min, significantly decreasing pain and significantly increasing subjective measures of abuse liability (e.g., high). Females had higher ratings of street value, high, and liking for one or both active doses. Conclusions: The CPT was a reliably painful and stressful stimulus that did not diminish the abuse liability of intranasal oxycodone. Females were more sensitive to oxycodone on several abuse liability measures that warrant further follow-up. Snorting oxycodone rapidly produced psychoactive effects indicative of substantial abuse liability.