Predicting aberrant drug behavior in patients treated for chronic pain: importance of abuse history

Abstract

Physicians can encounter problems in prescribing opioids for some patients with chronic pain such as multiple unsanctioned dose escalations, episodes of lost or stolen prescriptions, and positive urine drug screenings for illicit substances. This study explored the usefulness of questions on abuse history in predicting problems with prescribing opioids for patients at a hospital-based pain management program. One hundred forty-five (145) patients who were taking long- and short-acting opioids for their pain were classified as high or low risk on the basis of their responses to interview questions about 1) substance abuse history in their family, 2) past problems with drug or alcohol abuse, and 3) history of legal problems. The treating physicians completed a questionnaire about problems that they had encountered with their patients. Problem behaviors were verified through chart review. No differences in demographic characteristics were found between those classified as high and low risk. Patients who admitted to a family history of substance abuse, a history of legal problems, and drug or alcohol abuse were prone to more aberrant drug-related behaviors, including a higher incidence of lost or stolen prescriptions and the presence of illicit substances in their urine (P < 0.05). Patients classified as high risk also had a significantly higher frequency of reported mental health problems and motor vehicle accidents. More of these patients smoked cigarettes, tended to need a cigarette within the first hour of the day, took higher doses of opioids, and reported fewer adverse effects from the medications than did those without such a history (P < 0.05). This study demonstrates that questions about abuse history and legal problems can be useful in predicting aberrant drug-related behavior with opioid use in persons with chronic noncancer pain.

Pain, problem drug use history, and aberrant analgesic use behaviors in persons living with HIV

“…The present findings agree with previous work among non-HIV patients in which prior substance abuse emerged as one of the strongest risk factors for opiate misuse (Schofferman 1993;Dunbar and Katz 1996;Michna et al 2004). Schieffer et al (2005) in the largest study to date reported that chronic pain patients with a history of substance abuse evidenced higher rates of medication misuse compared to those without such history despite equivalent levels of prescribed opiates and similar self-ratings of medication effectiveness.…”

“…Research in non-HIV populations suggests that among individuals with chronic, nonmalignant pain, previous substance abuse is associated with an increased likelihood of opiate misuse (Schofferman 1993;Dunbar and Katz 1996;Michna et al 2004;Schieffer et al 2005). Although analogous investigations have not been conducted in HIV samples, it is likely that HIV patients with a problem drug use history would similarly evidence greater misuse of opiates than their non-problem-drug-using counterparts.…”

Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain

“…Our main independent variables were five risk factors for opioid misuse derived from prior research: (1) age <45 at the time of the first opioid prescription, [14][15][16][17]19 (2) current or past drug use disorder, 14,15,17,20 (3) current or past alcohol use disorder, 14,21 (4) current or past tobacco use, 21,25 and (5) current or past mental health disorder (i.e., anxiety, depression, bipolar disorder, post-traumatic stress disorder, or schizophrenia). 15,[20][21][22] These conditions were identified from ICD-9-CM coded diagnoses from inpatient and outpatient visits (available online).…”

“…15,[20][21][22] These conditions were identified from ICD-9-CM coded diagnoses from inpatient and outpatient visits (available online). Drug and alcohol use disorders were defined by an ICD-9-CM code for abuse, dependence, poisoning, withdrawal, or psychosis within our study timeframe.…”

“…19 Patients with a history of drug abuse or dependence have an increased risk of prescription opioid abuse or dependence 15 and up to six times greater risk of aberrant medication-related behaviors such as prescription forgery or obtaining opioids from lay persons. 14,17,20 Alcohol use disorders, 14,21 tobacco use, 21 and mental health disorders 15,[20][21][22] are also associated with an increased risk for opioid misuse.…”