Background/Purpose: Addictive medications, such as opiates and benzodiazepines are frequently prescribed to patients with chronic low back pain (cLBP). Little is known about illicit drug use among Americans with cLBP.

Methods: We used data from the back pain survey, administered to a representative sample of US adults aged 20-69 (N = 5103) during the 2009-2010 cycle of the National Health and Nutrition Examination Survey (NHANES). Participants who reported pain in the area between the lower posterior margin of the ribcage and the horizontal gluteal fold at the time of survey with a history of pain lasting almost every day for at least 3 months were classified as having cLBP (N = 700). The drug use questionnaire included data on lifetime and current use of marijuana or hashish, cocaine, heroin, and methamphetamine. Questions were self-administered in a private room using the Audio Computer-Assisted Self-Interviewing system. Chi-square tests, analysis of variance and logistic regression models, adjusted for age, gender, race and level of education, were used for comparisons. 

Results: US adults with cLBP were older, less educated, and more often Caucasian than those without cLBP. They had higher odds of unemployment, poverty, and depression. 46.5% of US adults with cLBP used marijuana vs 42% of those without cLBP (aOR 1.36, 95% CI 1.06-1.74, p=0.016). 22% vs 14% used cocaine (aOR 1.85, 95% CI 1.47-2.34, p<0.0001), 9% vs 5% used methamphetamine (aOR 2.03, 95% CI 1.30-3.16, p=0.002), and 5% vs 2% used heroin (aOR 2.43, 95% CI 1.44-4.11, p=0.001).

Conclusion: Community-based US adults with chronic low back pain had higher odds of using marijuana, cocaine, heroin, and methamphetamine than the general population. Particular caution should be exercised when prescribing medications with abuse potential to cLBP patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/illicit-drug-use-in-us-adults-with-chronic-low-back-pain-nhanes-2009-2010/