Reported lifetime aberrant drug-taking behaviors are predictive of current substance use and mental health problems in primary care patients.
Abstract
BACKGROUND: The aim of this report is to determine the frequency of aberrant drug
behaviors and their relationship to substance abuse disorders in a large primary sample
of patients receiving opioids for chronic pain. METHODS: The data utilized for this
report was obtained from 904 chronic pain patients receiving opioid therapy from their
primary care physician. A questionnaire was developed based on 12 aberrant drug behaviors
reported in the clinical literature. The diagnosis of a current substance use disorder
was determined using Diagnostic and Statistical Manual of Mental Disorders-Fourth
Edition(DSM-IV) criteria. RESULTS: The average duration of chronic pain in the sample
was 16 years and for opioid therapy, 6.4 years. Of the patients, 80.5% reported one
or more lifetime aberrant drug behaviors. The most frequent behaviors reported included
early refills (41.7%), increase dose without physician consent (35.7%), and felt intoxicated
from opioids (32.2%). Only 1.1% of subjects with 1-3 aberrant behaviors (N = 464,
51.2%) met DSM-IV criteria for current opioid dependence compared with 9.9% of patients
with four or more behaviors (N = 264, 29.3%). Persons with positive urine toxicology
tests for cocaine were 14 times more likely to report four or more behaviors than
no behaviors (14.1% vs 1.1%). A logistic model found that subjects who reported four
or more aberrant behaviors were more likely to have a current substance use disorder
(odds ratio [OR] 10.14; 3.72, 27.64), a positive test for cocaine (odds ratio [OR]
3.01; 1.74, 15.4), an Addiction Severity Index (ASI) psychiatric composite score >0.5
(OR 2.38; 1.65, 3.44), male gender (OR 2.08: 1.48, 2.92), and older age (OR 0.69;
0.59, 0.81) compared with subjects with three or fewer behaviors. Pain levels, employment
status, and morphine equivalent dose do not enter the model. CONCLUSIONS: Patients
who report four or more aberrant drug behaviors are associated with a current substance
use disorder and illicit drug use, whereas subjects with up to three aberrant behaviors
have a very low probability of a current substance abuse disorder. Four behaviors--oversedated
oneself, felt intoxicated, early refills, increase dose on own--appear useful as screening
questions to predict patients at greatest risk for a current substance use disorders.
Type
Journal articleSubject
AdolescentAdult
Analgesics, Opioid
Behavior, Addictive
Drug Evaluation, Preclinical
Drug Users
Female
Humans
Male
Mental Disorders
Middle Aged
Opioid-Related Disorders
Pain
Primary Health Care
Surveys and Questionnaires
Young Adult
Permalink
https://hdl.handle.net/10161/11691Published Version (Please cite this version)
10.1111/j.1526-4637.2008.00491.xPublication Info
Fleming, Michael F; Davis, James; & Passik, Steven D (2008). Reported lifetime aberrant drug-taking behaviors are predictive of current substance
use and mental health problems in primary care patients. Pain Med, 9(8). pp. 1098-1106. 10.1111/j.1526-4637.2008.00491.x. Retrieved from https://hdl.handle.net/10161/11691.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
Collections
More Info
Show full item recordScholars@Duke
James Davis
Associate Professor of Medicine
Dr. James Davis is a practicing physician of Internal Medicine, and serves as the
Medical Director for Duke Center for Smoking Cessation, Director of the Duke Smoking
Cessation Program and Co-Director of the Duke-UNC Tobacco Treatment Specialist Credentialing
Program. His research focuses on development of new pharmaceutical treatments for
smoking cessation. He is principal investigator on several trials including a study
on “adaptive” smoking cessation and several trials

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info