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Substance Use Disorders in a Primary Care Sample Receiving Daily Opioid Therapy

      Abstract

      The primary goal of this paper was to present a comprehensive picture of substance use disorders in a sample of patients receiving opioid therapy from their primary care physician. A second goal was to determine the relation of positive urine screens and aberrant drug behaviors to opioid use disorders. The study recruited 801 adults receiving daily opioid therapy from the primary care practices of 235 family physicians and internists in 6 health care systems in Wisconsin. The 6 most common pain diagnoses were degenerative arthritis, low back pain, migraine headaches, neuropathy, and fibromyalgia. The point prevalence of current (DSM-IV criteria in the past 30 days) substance abuse and/or dependence was 9.7% (n = 78) and 3.8% (30) for an opioid use disorder. A logistic regression model found that current substance use disorders were associated with age between 18 and 30 (OR = 6.17: 1.99 to 19.12), severity of lifetime psychiatric disorders (OR = 6.17; 1.99 to 19.12), a positive toxicology test for cocaine (OR = 5.92; 2.60 to 13.50) or marijuana (OR = 3.52; 1.85 to 6.73), and 4 aberrant drug behaviors (OR = 11.48; 6.13 to 21.48). The final model for opioid use disorders was limited to aberrant behaviors (OR = 48.27; 13.63 to 171.04) as the other variables dropped out of the model.

      Perspective

      This study found that the frequency of opioid use disorders was 4 times higher in patients receiving opioid therapy compared with general population samples (3.8% vs 0.9%). The study also provides quantitative data linking aberrant drug behaviors to opioid use disorders.

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      References

        • Ackini I.
        • Tartar R.
        • Kirisci H.
        Concordance between verbal report and urine screen of recent marijuana use in adolescents.
        Addict Behav. 2001; 25: 613-619
        • American Pain Society
        Definitions related to the use of opioids for the treatment of pain: A consensus document from the American Academy of Pain Medicine, the American Pain Society and the American Society of Addiction Medicine. 2001
        • Ballantyne J.
        • Mao J.
        Opioid therapy for chronic pain.
        N Engl J Med. 2003; 349: 1943-1953
        • Brookoff D.
        Chronic pain: A new disease?.
        Hosp Pract (Minneapolis). 2000; 35: 45-52
        • Chelminski P.
        • Ives T.
        • Felix K.
        • Prakken S.
        • Miller T.
        • Perhac J.
        • Malone R.
        • Bryant M.
        • DeWalt D.A.
        • Pignone M.
        A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity.
        BMC Health Serv Res. 2005; 5: 3
        • Compton P.
        • Darakjian J.
        • Miotto K.
        Screening for addiction in patients with chronic pain and ‘problematic’ substance use: Evaluation of a pilot assessment tool.
        J Pain Sympt Manage. 1998; 16: 355-363
        • Cowan D.
        • Wilson-Barnett J.
        • Griffiths P.
        • Allan L.
        A survey of chronic non-cancer pain patients prescribed opioid analgesics.
        Pain Med. 2003; 4: 340-351
        • Diamond S.
        • Freitag F.
        • Solomon G.
        • Millstein E.
        Migraine headache: Working for the best outcome.
        Postgrad Med. 1987; 81: L174-L176
        • Fishbain D.
        • Rosomoff H.
        • Rosomoff R.
        Drug abuse, dependence, and addiction in chronic pain patients.
        Clin J Pain. 1992; 8: 77-85
        • Gureje O.
        • Von Korff M.
        • Simon G.
        • Gater R.
        Persistent pain and well being: A world Health Organization Study in Primary Care.
        JAMA. 1998; 280: 147-151
        • Martell B.
        • O’Connor P.
        • Kerns R.
        • Becker W.
        • Morales K.
        Systematic review: Opioid treatment for chronic back pain: Prevalence, efficacy and association with addiction.
        Ann Intern Med. 2007; 146: 116-127
        • McLellan A.T.
        • Kushner H.
        • Metzger D.
        • Peters R.
        • Smith I.
        • Grissom G.
        • Pettinati H.
        • Argeriou M.
        The fifth edition of the Addiction Severity Index.
        J Substance Abuse Treat. 1992; 9: 199-213
        • McQuay H.
        Opioids in pain management.
        Lancet. 1999; 353: 2229-2232
        • Miele G.
        • Carpenter K.
        • Smith Cockerham M.
        • Dietz Trautman K.
        • Blaine J.
        • Hasin D.
        Concurrent and predictive validity of the Substance Dependence Severity Scale (SDSS).
        Drug Alcohol Depend. 2000; 59: 77-88
        • Novak S.
        • Nemeth W.
        • Lawson K.
        Trends in medical use and abuse of sustained-release opioid analgesics: A revisit.
        Pain Med. 2004; 5: 59-65
        • Passik S.
        • Kirsh K.
        Assessing aberrant drug taking behaviors in the patient with chronic pain.
        Curr Pain Headache Rep. 2004; 8: 289-294
        • Passik S.
        • Kirsh K.
        • Whitcomb L.
        • Dickerson P.
        • Theobald D.E.
        Pain clinicians’ rankings of aberrant drug-taking behaviors.
        J Pain Palliat Care Pharmacother. 2002; 16: 39-49
        • Perry S.
        • Heidrich G.
        Management of pain during debridement: A survey of US burn units.
        Pain. 1982; 13: 267-280
        • Portenoy R.
        Chronic opioid therapy in non malignant pain.
        J Pain Symptom Manage. 1990; 5: S46-S62
        • Porter J.
        • Jick H.
        Addiction rate in patients treated with narcotics.
        N Engl J Med. 1980; 302: 123
        • Reid M.
        • Engles-Horton L.
        • Weber M.
        • Kerns R.
        • Rogers E.
        Use of opioid medications for chronic non cancer pain syndrome in primary care.
        J Gen Intern Med. 2002; 17: 173-179
        • Savage S.
        Long-term opioid therapy: Assessment of consequences and risks.
        J Pain Symptom Manage. 1996; 11: 274-286
        • Stewart W.
        • Ricci J.
        • Chee E.
        • Morganstein D.
        • Lipton R.
        Lost productive time and cost due to common pain conditions in the US workforce.
        JAMA. 2003; 290: 2443-2454
      1. Substance Abuse and Mental health Services Administration (SAMHSA) Office of Applied Studies. Results from the 2005 National Survey on Drug Use and Health: National Findings. http://www.oas.samhsa.gov/nsduh.htm. Pages 71-75.

        • Waisman D.
        • Haddox J.
        Opioid pseudo addiction: An iatrogenic syndrome.
        J Pain Symptom Manage. 2000; 19: 274-286
        • Webster L.
        • Webster R.
        Predicting aberrant behaviors in opioid treated patients: Preliminary validation of the opioid risk tool.
        Pain Med. 2005; 6: 432-438
        • Wilson P.
        Opioid use and diversion: report on recent hearing by FDA and DEA: ASA statement to FDA committee.
        ASA Newsletter. 2002; 66: 9-10