Patients with Chronic Pain and a Prescription Drug Use Disorder Have Easily Identifiable Risk Factors

A number of studies have identified risk factors for prescription drug use disorders (PDUDs) but were limited by pain-clinic settings and reliance on proxy measures such as aberrant medication-taking behaviors or urine testing. In this study, patients with chronic pain who were taking prescription or nonprescription analgesics were recruited from the waiting room of an urban primary-care clinic. Researchers used DSM-IV criteria to identify patients with lifetime drug abuse or dependence or current alcohol dependence.

• Of 597 patients interviewed, 110 (18.4%) met criteria for lifetime PDUD, and 146 (24.5%) met criteria for another substance use disorder (SUD). Ninety percent of patients with PDUD also met criteria for SUD.

• Risk factors associated with PDUD included time in jail (odds ratio [OR], 5.1), greater pain-related limitations (OR, 3.8), smoking (OR, 3.6), family history of substance abuse (OR, 3.4), white race (OR, 3.2), male gender (OR, 1.9), and PTSD (OR, 1.9).

• Risk factors for SUD were the same but also included intimate partner violence and depression.

• All patients with PDUD had at least 2 risk factors, and 93% of those with 6 or more risk factors had PDUD.

Comments:

This study shows patients at risk for PDUD can be identified using a few easy questions. The difficult question is what we should do to help these patients. At the very least, closer monitoring and judicious prescribing of opioids and sedatives is warranted.

Darius A. Rastegar, MD

Reference:

Liebschutz JM, Saitz R, Weiss RD, et al. Clinical factors associated with prescription drug use disorder in urban primary care patients with chronic pain. J Pain. 2010; 11(11):1047–1055.