Craving for opioid and cannabis use among adults with chronic pain: Insights from a 30-day ecological momentary assessment study.

Background: Craving is an aversive state and risk factor for progression to nonmedical substance use. The aims of this secondary analysis of Ecological Momentary Assessment (EMA) data were 1) to test whether craving was elevated on days of co-use of opioids and cannabis, and 2) to examine pain, pain catastrophizing, affect, and stress as risk factors for current and next-moment craving, among patients with chronic pain.

Methods: Adults with chronic pain (N = 46) who used both opioids and cannabis were recruited online and completed a 30-day EMA study, consisting of four momentary surveys per day that assessed opioids and cannabis craving, use, pain and pain catastrophizing, affect, and stress. Linear mixed effects models estimated associations between pain, pain catastrophizing, affect, and stress with craving, at the same occasion and prospectively.

Results: Most participants experienced some craving, though about a third of participants included in analyses reported minimal or no craving for the duration of the study. Craving for opioids and cannabis was higher on days of co-use and in the context of greater pain catastrophizing; smaller effects were observed correlating pain intensity, affect, and stress to opioid and cannabis craving. In adjusted analyses, pain catastrophizing prospectively predicted future opioid craving, albeit the effect was small.

Conclusions: The findings highlight that subset of patients do not report experiencing craving, but those who do tend to experience craving on days with heightened pain intensity and catastrophizing. Future research should investigate the role of pain catastrophizing in craving among patients with chronic pain.