• Martin D Cheatle, Mary Falcone, Lara Dhingra, and Caryn Lerman.
• Department of Psychiatry, Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA. Electronic address: cheatle@pennmedicine.upenn.edu.
• Drug Alcohol Depend. 2020 Apr 1; 209: 107901.

BackgroundThe harms associated with prescription opioid abuse have become a public health crisis. There is a need for evidence-based objective markers of the risk of opioid use disorder (OUD) in patients with pain receiving opioid treatment. The objective of this study was to evaluate the independent association of tobacco use and OUD in patients with chronic non-cancer pain.MethodsThis cross-sectional naturalistic study evaluated 798 adults ≥ 18 years with chronic non-cancer pain treated with long-term opioid therapy (≥ 6 months) who either developed an OUD (cases, n = 216) or displayed no evidence of an OUD (controls, n = 582). The primary outcome was presence of OUD. In addition to current self-reported tobacco use (primary predictor), covariates included demographics, pain severity, and psychiatric history. Data were collected between November 2012 and September 2018.ResultsCurrent tobacco use independently was strongly associated with OUD [odds ratio (OR) 14.0, 95 % confidence interval (CI) 9.5-20.6, p < 0.001], and this association remained significant after adjusting for other risk factors [adjusted odds ratio (aOR) 7.6, 95 % CI 4.8-12.2, p < 0.001]. Other factors associated independently with development of OUD included age, marital status, financial status, education and pain severity.Conclusions And RelevanceCurrent tobacco use is significantly associated with OUD in patients with chronic pain receiving long-term opioid therapy.Copyright © 2020 Elsevier B.V. All rights reserved.

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