Understanding the Ways that Chronic Pain, Depression Symptoms, and Resilience Affect Retention in and Adherence to Medications for Opioid Use Disorder Treatment

The qualitative and quantitative findings shed light on the complex, bidirectional relationships between mental and physical health in a sample of patients with OUD. For example, multiple measures of pain experience were related to depression. Notably, many participants described using opioids to improve physical or mental functioning. Greater pain interference was associated with a greater number of prior treatment episodes, which suggests that functional impairment likely persists during ongoing opioid use and may motivate ongoing treatment. In addition, participants described opioid intoxication as numbing mental and physical pain at some times but worsening both at others. Symptoms of depression (e.g., sadness, anhedonia, lethargy) overlap with symptoms of opioid intoxication, and, for some patients, symptoms of physical pain overlap with symptoms of opioid withdrawal. Overall, our findings highlight the importance of using a comprehensive treatment approach to address physical and emotional distress that frequently precedes and co-occurs with opioid addiction. These findings suggest that addressing co-occurring physical and mental health concerns during MOUD treatment has the potential to improve treatment engagement and abstinence from illicit opioids. To do this, treatment providers can inquire about chronic pain and depression when providing MOUD to individualize patient care. Incorporating evidence-based, nonpharmacological pain and depression interventions such as Cognitive Behavioral Therapy for Chronic Pain or Depression may improve outcomes by addressing common experiences before and during OUD.