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AIM To assess the role of momentary pain on opioid craving and illicit opioid use among individuals receiving opioid agonist treatment. DESIGN Observational study using ecological momentary assessment. SETTING The National Institute of Drug Abuse Intramural Research Program in the United States. PARTICIPANTS Fifty-six adults who qualified for opioid agonist treatment. MEASUREMENTS Participants completed randomly prompted assessments of pain severity, stress, negative mood, opioid craving and illicit opioid use for a mean of 66 days [standard deviation (SD) = 27]. Urine samples were collected two to three times/week throughout. FINDINGS Almost 70% of participants reported moderate average pain severity in the past 24 hours at intake and 35% of participants reported chronic pain. There were no significant differences in percent of opioid-positive urine samples (P = 0.73) and average level of opioid craving during the study period (P = 0.91) among opioid agonist treatment only patients versus opioid agonist treatment patients with chronic pain. However, momentary pain severity significantly predicted concurrent opioid craving [B = 0.02, 95% confidence interval (CI) = 0.01, 0.04], over and above stress and negative mood. Momentary opioid craving, in turn, significantly predicted illicit opioid use that was assessed in the next moment [odds ratio (OR) = 1.72, 95% CI = 1.12, 2.64), while controlling for autocorrelation and the effects of pain, negative mood and stress. Momentary opioid craving significantly mediated the prospective association between momentary pain and illicit opioid use (95% CI = 0.003, 0.032). Exploratory analysis revealed that momentary pain severity also significantly moderated the momentary association between stress and opioid craving (B = 0.02, 95% CI = 0.00, 0.04), such that when momentary pain severity increased, the association between the two intensified. CONCLUSIONS Among people receiving opioid agonist treatment, momentary pain appears to be indirectly associated with illicit opioid use via momentary opioid craving.

Aims Clinical trials test the safety and efficacy of behavioral and pharmacological interventions in drug-dependent individuals. However, there is no consensus about the most appropriate outcome(s) to consider in determining treatment efficacy or on the most appropriate methods for assessing selected outcome(s). We summarize the discussion and recommendations of treatment and research experts, convened by the US National Institute on Drug Abuse, to select appropriate primary outcomes for drug dependence treatment clinical trials, and in particular the feasibility of selecting a common outcome to be included in all or most trials. Methods A brief history of outcomes employed in prior drug dependence treatment research, incorporating perspectives from tobacco and alcohol research, is included. The relative merits and limitations of focusing on drug-taking behavior, as measured by self-report and qualitative or quantitative biological markers, are evaluated. Results Drug-taking behavior, measured ideally by a combination of self-report and biological indicators, is seen as the most appropriate proximal primary outcome in drug dependence treatment clinical trials. Conclusions We conclude that the most appropriate outcome will vary as a function of salient variables inherent in the clinical trial, such as the type of intervention, its target, treatment goals (e.g. abstinence or reduction of use) and the perspective being taken (e.g. researcher, clinical program, patient, society). It is recommended that a decision process, based on such trial variables, be developed to guide the selection of primary and secondary outcomes as well as the methods to assess them.

Aims—To determine whether cannabinoid-positive urine specimens in heroin-dependent outpatients predict other drug use or impairments in psychosocial functioning, and whether such outcomes are better predicted by cannabis-use disorders than by cannabis use itself. Design—Retrospective analyses of three clinical trials; each included a behavioral intervention (contingency management) for cocaine or heroin use during methadone maintenance. Trials lasted 25–29 weeks; follow-up evaluations occurred 3, 6, and 12 months posttreatment. For the present analyses, data were pooled across trials where appropriate. Setting—Urban outpatient methadone clinic. Participants—408 polydrug abusers meeting methadone-maintenance criteria. Measurements—Participants were categorized as nonusers, occasional users, or frequent users of cannabis based on thrice-weekly qualitative urinalyses. Cannabis-use disorders were assessed with the Diagnostic Interview Schedule III-R. Outcome measures included proportion of cocaine- and opiate-positive urines and the Addiction Severity Index (at intake and follow-ups). Findings—Cannabis use was not associated with retention, use of cocaine or heroin, or any other outcome measure during or after treatment. Our analyses had a power of .95 to detect an r 2 of .11 between cannabis use and heroin or cocaine use; the r 2 we detected was less than .03 and nonsignificant. A previous finding that cannabis use predicted lapse to heroin use in heroin-abstinent patients did not replicate in our sample. However, cannabis-use disorders were weakly associated with psychosocial problems at posttreatment follow-up. Conclusions—Cannabinoid-positive urines need not be a major focus of clinical attention during treatment for opiate dependence, unless patients report symptoms of cannabis-use disorders.

Les methodes d'analyses d'urines qualitatives utilisees pour enregistrer l'usage de cocaine peuvent surevaluer la frequence d'usage, diminuant probablement la capacite des essais cliniques a detecter les traitements efficaces. Les analyses d'urines quantitatives et les criteres developpes recemment pour identifier les nouveaux emplois de cocaine ont ete evalues en tant que mesures alternatives d'usage de cocaine. Les echantillons d'urines recueillis dans une etude de dosage de la cocaine chez des sujets ne suivant pas de traitement (n = 5) et chez d'autres sujets participant a une experience de traitement pour cocainomanes (n=37) ont ete analyses pour le metabolite de la cocaine, le benzoylecgonine, avec des methodes qualitatives et quantatives. Les criteres pharmacocinetiques (regles nouvel usage) ont ete appliques aux donnees quantitatives pour identifier les cas de nouvelle utilisation de cocaine. Les resultats ont ete compares aux administrations connues de cocaine dans l'etude en laboratoire et a l'usage de drogue autoreporte ainsi qu'aux analyses d'urines qualitatives pour les sujets de l'experience clinique. Les criteres Nouvel Usage ont identifie correctement les administrations de cocaine dans l'etude de dosage de la cocaine pour pratiquement tous les echantillons. Dans l'essai clinique, l'analyse d'urines quantitative et les nouveaux modes d'emploi estimes ont fourni davantage d'informations au sujet des modeles et de la frequence d'usage que les analyses d'urines qualitatives dans les differentes conditions de traitement dans l'essai clinique. L'interpretation des analyses d'urines quantitatives avec les normesnouvel usage semble etre une methode utile pour enregistrer les resultats du traitement et peut etre plus precise que les analyses d'urines qualitatives traditionnelles en estimant la frequence d'usage de cocaine.

The drug discrimination paradigm, which is sometimes considered to provide an animal model of human subjective effects, has been adapted for use with human subjects. This procedure provides a direct measure of stimulus similarity between the test drug and a known standard drug, information that may be of value in predicting abuse liability of novel compounds. The present paper reviews the general methods used in human drug discrimination studies, some of the drugs that have been tested, factors to consider in designing drug discrimination studies in humans, and evidence concerning the utility of the procedure in abuse liability assessment. Further research is needed to validate this procedure and to determine the conditions under which it has the greatest value in abuse liability assessment.