A short communication of pain outcomes following a pharmacist-delivered alcohol and opioid use reduction intervention

Background: Co-use of alcohol and opioid medications increases risk for sedation, respiratory depression, and overdose, yet remains common among patients prescribed opioids. The Alcohol Brief Intervention-Medication Therapy Management (ABI-MTM) intervention was developed for delivery by community pharmacists and demonstrated feasibility, acceptability, and preliminary reductions in co-use. Given possible pain-related motives for co-use, this exploratory secondary analysis assessed whether ABI-MTM affected pain symptomatology. Methods: This study utilized data from a randomized trial of 44 community pharmacy patients from 25 pharmacies prescribed opioids and who reported alcohol co-use. Participants were randomized to ABI-MTM or standard medication counseling (SMC). Pain intensity/interference were assessed at baseline, 2-, and 3-months using the Brief Pain Inventory-Short Form. Analyses included descriptive statistics, Cohen's d effect sizes, and mixed-effects models comparing pain across conditions and timepoints. Results: Pain scores did not differ between groups (p > 0.05). For pain intensity, ABI-MTM and SMC showed similar baseline means (4.31 vs. 5.05), decreased modestly at 2-months (2.80 vs. 3.74), and returned to baseline levels at 3-months (4.21 vs. 4.83). Pain interference followed a comparable pattern, with ABI-MTM and SMC starting similarly (4.83 vs. 5.07), decreasing modestly at 2-months (3.19 vs. 3.87), and returning near baseline at 3-months (4.92 vs. 4.42). Effect sizes between group differences were small (Cohen's d≤0.33). Mixed-model analyses showed no significant treatment effects on pain intensity/interference across time (p > 0.05). Conclusions: This underpowered study found no evidence of pain differences between ABI-MTM and SMC, tentatively suggesting possible alcohol-opioid co-use improvements associated with the intervention without worsening pain.