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

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’.