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

Passik, Steven D

England

2016-03-02T13:55:47Z

2008-11

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.

http://www.ncbi.nlm.nih.gov/pubmed/18721174

PME491

1526-4637

https://hdl.handle.net/10161/11691

eng

Oxford University Press (OUP)

Pain Med

10.1111/j.1526-4637.2008.00491.x

Adolescent

Adult

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

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

Journal article

Davis, James|0000-0002-7196-5649

http://www.ncbi.nlm.nih.gov/pubmed/18721174

1098

1106

8

Clinical Science Departments

Duke

Duke Cancer Institute

Institutes and Centers

Medicine

Medicine, Hospitalists

School of Medicine

Published

9