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Reported lifetime aberrant drug-taking behaviors are predictive of current substance use and mental health problems in primary care patients.

dc.contributor.author Fleming, MF
dc.contributor.author Davis, J
dc.contributor.author Passik, SD
dc.coverage.spatial England
dc.date.accessioned 2016-03-02T13:55:47Z
dc.date.issued 2008-11
dc.identifier http://www.ncbi.nlm.nih.gov/pubmed/18721174
dc.identifier PME491
dc.identifier.uri https://hdl.handle.net/10161/11691
dc.description.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.
dc.language eng
dc.relation.ispartof Pain Med
dc.relation.isversionof 10.1111/j.1526-4637.2008.00491.x
dc.subject Adolescent
dc.subject Adult
dc.subject Analgesics, Opioid
dc.subject Behavior, Addictive
dc.subject Drug Evaluation, Preclinical
dc.subject Drug Users
dc.subject Female
dc.subject Humans
dc.subject Male
dc.subject Mental Disorders
dc.subject Middle Aged
dc.subject Opioid-Related Disorders
dc.subject Pain
dc.subject Primary Health Care
dc.subject Surveys and Questionnaires
dc.subject Young Adult
dc.title Reported lifetime aberrant drug-taking behaviors are predictive of current substance use and mental health problems in primary care patients.
dc.type Journal article
pubs.author-url http://www.ncbi.nlm.nih.gov/pubmed/18721174
pubs.begin-page 1098
pubs.end-page 1106
pubs.issue 8
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Duke Cancer Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Medicine
pubs.organisational-group Medicine, Hospitalists
pubs.organisational-group School of Medicine
pubs.publication-status Published
pubs.volume 9
dc.identifier.eissn 1526-4637


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