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Research Summary

Patients Who Receive Opioids for Chronic Pain Are Inadequately Managed

Approximately 10% of primary-care patients with chronic noncancer pain (CNCP) have a current substance use disorder (SUD). Treatment guidelines recommend that patients with an SUD who are treated with opioids require more intensive monitoring and treatment. This study of 5814 Veterans Affairs patients prescribed opioids for 90 or more consecutive days in 2008 compared provider adherence to guideline-recommended practices among patients with and without an SUD diagnosis in the prior year.

  • Twenty percent of patients prescribed opioids had an SUD.
  • Patients with an SUD were more likely than those without to have had a mental health appointment (30% versus 17%) and a urine drug screen (47% versus 18%).
  • There was no difference between groups in:
    • primary-care follow-up ≥4 times per year (63% versus 61%),
    • use of long-acting opioids (27% versus 26%),
    • antidepressant use among those with depression (88% versus 86%), or
    • participation in physical therapy (31% versus 29%).
  • Only 35% of patients with an SUD received substance abuse treatment.


This study shows that the use of guideline-recommended management practices among patients prescribed opioids for CNCP is suboptimal. Less than half of patients with an SUD who received opioids for CNCP underwent urine toxicology screening, and the limited uptake of substance abuse treatment is noteworthy. Unless clinical practices improve, greater restrictions on the use of opioids are inevitable. The epidemic of prescription opioid abuse is causing some to call for a moratorium on opioid use for CNCP. Physicians should embrace the national momentum toward education and practice improvement in the management of patients who benefit from prescription opioids. Peter D. Friedmann, MD, MPH


Morasco BJ, Duckart JP, Dobscha SK. Adherence to clinical guidelines for opioid therapy for chronic pain in patients with substance use disorder. J Gen Intern Med. 2011;26(9):965–971.