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Clinical Factors Associated With Prescription Drug Use Disorder in Urban Primary Care Patients with Chronic Pain

  • Jane M. Liebschutz
    Correspondence
    Address reprint requests to Dr. Jane Liebschutz, Section of General Internal Medicine, Boston Medical Center, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118-2334.
    Affiliations
    Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, and Department of Medicine, Boston University School of Medicine, Boston, Massachusetts

    Department of Social and Behavioral Sciences, Boston University School of Public Health, Boston, Massachusetts
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  • Richard Saitz
    Affiliations
    Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, and Department of Medicine, Boston University School of Medicine, Boston, Massachusetts

    Youth Alcohol Prevention Center, Boston University School of Public Health, Boston, Massachusetts

    Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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  • Roger D. Weiss
    Affiliations
    Harvard Medical School and McLean Hospital, Boston, Massachusetts
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  • Tali Averbuch
    Affiliations
    University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
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  • Sonia Schwartz
    Affiliations
    Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, and Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
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  • Ellen C. Meltzer
    Affiliations
    Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, and Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
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  • Elizabeth Claggett-Borne
    Affiliations
    Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, and Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
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  • Howard Cabral
    Affiliations
    Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
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  • Jeffrey H. Samet
    Affiliations
    Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, and Department of Medicine, Boston University School of Medicine, Boston, Massachusetts

    Department of Social and Behavioral Sciences, Boston University School of Public Health, Boston, Massachusetts
    Search for articles by this author

      Abstract

      This study examined characteristics associated with prescription drug use disorder (PDUD) in primary-care patients with chronic pain from a cross-sectional survey conducted at an urban academically affiliated safety-net hospital. Participants were 18 to 60 years old, had pain for >3 months, took prescription or nonprescription analgesics, and spoke English. Measurements included the Composite International Diagnostic Interview (PDUD, other substance use disorders (SUD), Posttraumatic Stress Disorder [PTSD]); Graded Chronic Pain Scale, smoking status; family history of SUD; and time spent in jail. Of 597 patients (41% male, 61% black, mean age 46 years), 110 (18.4%) had PDUD of whom 99 (90%) had another SUD. In adjusted analyses, those with PDUD were more likely than those without any current or past SUD to report jail time (OR 5.1, 95% CI 2.8–9.3), family history of SUD (OR 3.4, 1.9-6), greater pain-related limitations (OR 3.8, 1.2-11.7), cigarette smoking (OR 3.6, 2–6.2), or to be white (OR 3.2, 1.7–6), male (OR 1.9, 1.1–3.5) or have PTSD (OR 1.9, 1.1–3.4). PDUD appears increased among those with easily identifiable characteristics. The challenge is to determine who, among those with risk factors, can avoid, with proper management, developing the increasingly common diagnosis of PDUD.

      Perspective

      This article examines risk factors for prescription drug use disorder (PDUD) among a sample of primary-care patients with chronic pain at an urban, academic, safety-net hospital. The findings may help clinicians identify those most at risk for developing PDUD when developing appropriate treatment plans.

      Key words

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