‘I crave not to feel uncomfortable’ – investigating craving for opioids and cannabis among individuals with chronic pain

Abstract

Background

The assessment of drug craving is common in survey studies, including those using real-time data collection methods, such as Ecological Momentary Assessment (EMA). However, few studies investigate how participants with chronic pain interpret the word ‘craving’ and how interpretations impact survey responses.

Methods

We conducted a mixed-methods study among 12 individuals with chronic pain who were using prescription opioids and cannabis. Participants completed baseline surveys, cognitive interviews, and 14-day smartphone-based EMA data collection. Analyses included deductive and inductive coding of interviews and t-tests of EMA self-reports of opioid and cannabis craving.

Results

Four participants had negative reactions to the word ‘craving’, including mentions that these questions offended them. The remaining eight participants mentioned no negative connotation. EMA data showed that participants without negative reactions reported a greater range (opioids), higher standard deviation (opioids), and higher maximum (opioids, cannabis) on Likert-type EMA craving items, compared to those with a negative reaction.

Conclusions

Some individuals with chronic pain may have a negative reaction to the word ‘craving’ related to opioid and cannabis use and this reaction may impact survey responses. Alternative wording of survey items is recommended, for example focused on ‘wanting’ or ‘needing’.

Keywords:

• Opioids
• cannabis
• craving
• ecological momentary assessment
• mixed methods

Authors’ contributions

Johannes Thrul: conceptualization; formal analysis; funding acquisition; investigation; methodology; writing – first draft; writing – review & editing. Courtney D. Nordeck: formal analysis; investigation; writing – review & editing. Janardan Devkota: data curation; formal analysis; visualization; writing – review & editing. Chung Jung Mun: writing – review & editing. Kelly E. Dunn: writing – review & editing. Cecilia L. Bergeria: writing – review & editing. Vadim Zipunnikov: writing – review & editing. Ryan Vandrey: writing – review & editing. Patrick H. Finan: conceptualization; writing – review & editing.

Disclosure statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: PHF is on the advisory board for Ninnion Therapeutics. RV has received consulting fees and honoraria for service on the scientific advisory board for the following companies within the past 12 months: Canopy Growth Corporation, MyMD Pharmaceuticals Inc., Mira Pharmaceuticals, Syqe Medical Ltd, Jazz Pharmaceuticals, WebMD. In the past 3 years, KED has been paid as a consultant for Canopy, MindMed, and Cessation Therapeutics; received honoraria for advisory board work for Canopy Corporation and Beckley-Canopy; and received research and salary support from the National Institutes on Drug Abuse and Cure Addiction Now.

Additional information

Funding

This work was supported by the National Institute on Drug Abuse (R21DA048175; T32DA007292). The sponsor had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.