Reported Lifetime Aberrant Drug-Taking Behaviors Are Predictive of Current Substance Use and Mental Health Problems in Primary Care Patients

Fleming, Michael F.; Davis, James M.; Passik, Steven D.

doi:10.1111/j.1526-4637.2008.00491.x

Cited by 65 publications

(48 citation statements)

References 34 publications

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“…Four specifi c behaviors were most strongly associated with an SUD: oversedation on purpose, feeling of intoxication, early refi lls, and increased dose on own. Those who screened positive for cocaine use were 14 times more likely to have an SUD [52].…”

Section: Identifi Cation Of Substance Use Disordersmentioning

confidence: 98%

Management of opioid medications in patients with chronic pain and risk of substance misuse

Savage

2009

Curr Psychiatry Rep

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When prescribed appropriately and used as prescribed, opioid medications can safely and effectively treat pain. Best practices with respect to their use in chronic non-cancer-related pain (CNCP) are evolving. Opioids may be subject to misuse for a variety of purposes, including self-medication, use for reward, compulsive use because of addiction, and diversion for profit. Individuals with chronic pain and co-occurring substance use, mental health disorders, and other conditions may be at increased risk for misuse of prescribed opioids. Interdisciplinary pain management, the use of universal precautions in all patients, and special attention to the structure of care in those at higher risk for opioid misuse may improve outcomes in opioid treatment of CNCP. This article discusses evolving research and clinical literature related to the care of individuals with CNCP at a higher risk for opioid misuse.

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Section: Identifi Cation Of Substance Use Disordersmentioning

confidence: 98%

Management of opioid medications in patients with chronic pain and risk of substance misuse

Savage

2009

Curr Psychiatry Rep

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“…Finally, when the original study included a psychometric evaluation of a questionnaire and used nonquestionnaire data to evaluate issues of sensitivity and specificity (eg, in the identification of questionnaire cut-scores), then rates of problematic use from the nonquestionnaire data were recorded (eg, Ref. 21).…”

Section: Coding Of Current Opioid Misuse Abuse and Addictionmentioning

confidence: 99%

Rates of opioid misuse, abuse, and addiction in chronic pain

Vowles

McEntee

Julnes

et al. 2015

Pain

1,011

665

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Opioid use in chronic pain treatment is complex, as patients may derive both benefit and harm. Identification of individuals currently using opioids in a problematic way is important given the substantial recent increases in prescription rates and consequent increases in morbidity and mortality. The present review provides updated and expanded information regarding rates of problematic opioid use in chronic pain. Because previous reviews have indicated substantial variability in this literature, several steps were taken to enhance precision and utility. First, problematic use was coded using explicitly defined terms, referring to different patterns of use (ie, misuse, abuse, and addiction). Second, average prevalence rates were calculated and weighted by sample size and study quality. Third, the influence of differences in study methodology was examined. In total, data from 38 studies were included. Rates of problematic use were quite broad, ranging from <1% to 81% across studies. Across most calculations, rates of misuse averaged between 21% and 29% (range, 95% confidence interval [CI]: 13%-38%). Rates of addiction averaged between 8% and 12% (range, 95% CI: 3%-17%). Abuse was reported in only a single study. Only 1 difference emerged when study methods were examined, where rates of addiction were lower in studies that identified prevalence assessment as a primary, rather than secondary, objective. Although significant variability remains in this literature, this review provides guidance regarding possible average rates of opioid misuse and addiction and also highlights areas in need of further clarification.

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“…For example, Fleming et al 12 measured a point prevalence of opioid abuse disorders at 3.8% of COT patients but reported much higher rates of opioid misuse. 13 Boscarino et al 6 estimated the prevalence of DSM-4 opioid abuse and dependence at 26%. Højsted et al 15 found a prevalence rate for addiction of 14.4% or 19.3% depending on the definition used.…”

Section: Introductionmentioning

confidence: 99%

The prevalence of problem opioid use in patients receiving chronic opioid therapy

Palmer

Carrell

Cronkite

et al. 2015

Pain

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To estimate the prevalence of problem opioid use, we used natural language processing (NLP) techniques to identify clinical notes containing text indicating problem opioid use from over 8 million electronic health records (EHRs) of 22,142 adult patients receiving chronic opioid therapy (COT) within Group Health clinics from 2006 to 2012. Computer-assisted manual review of NLP-identified clinical notes was then used to identify patients with problem opioid use (overuse, misuse, or abuse) according to the study criteria. These methods identified 9.4% of patients receiving COT as having problem opioid use documented during the study period. An additional 4.1% of COT patients had an International Classification of Disease, version 9 (ICD-9) diagnosis without NLP-identified problem opioid use. Agreement between the NLP methods and ICD-9 coding was moderate (kappa = 0.61). Over one-third of the NLP-positive patients did not have an ICD-9 diagnostic code for opioid abuse or dependence. We used structured EHR data to identify 14 risk indicators for problem opioid use. Forty-seven percent of the COT patients had 3 or more risk indicators. The prevalence of problem opioid use was 9.6% among patients with 3 to 4 risk indicators, 26.6% among those with 5 to 6 risk indicators, and 55.04% among those with 7 or more risk indicators. Higher rates of problem opioid use were observed among young COT patients, patients who sustained opioid use for more than 4 quarters, and patients who received higher opioid doses. Methods used in this study provide a promising approach to efficiently identify clinically recognized problem opioid use documented in EHRs of large patient populations. Computer-assisted manual review of EHR clinical notes found a rate of problem opioid use of 9.4% among 22,142 COT patients over 7 years.

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Reported Lifetime Aberrant Drug-Taking Behaviors Are Predictive of Current Substance Use and Mental Health Problems in Primary Care Patients

Cited by 65 publications

References 34 publications

Management of opioid medications in patients with chronic pain and risk of substance misuse

Management of opioid medications in patients with chronic pain and risk of substance misuse

Rates of opioid misuse, abuse, and addiction in chronic pain

The prevalence of problem opioid use in patients receiving chronic opioid therapy

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