Timothy J. Ives|Paul R. Chelminski|Catherine A. Hammett?Stabler|Robert M. Malone|J. Stephen Perhac|Nicholas M. Potisek|Betsy Bryant Shilliday|Darren A. DeWalt|Michael Pignone
Predictors of opioid misuse in patients with chronic pain: a prospective cohort study
University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill
opioid misuse complicate chronic pain management nonmedical use opioids growing public health problem incidence risk factors opioid misuse patients chronic pain however well characterized conducted prospective cohort study determine oneyear incidence predictors opioid misuse among patients enrolled chronic pain disease management program within academic internal medicine practiceonehundred ninetysix opioidtreated patients chronic noncancer pain least three months duration monitored opioid misuse predefined intervals opioid misuse defined 1 negative urine toxicological screen uts prescribed opioids 2 uts positive opioids controlled substances prescribed practice 3 evidence procurement opioids multiple providers 4 diversion opioids 5 prescription forgery 6 stimulants cocaine amphetamines utsthe mean patient age 52 years 55 male 75 white sixtytwo 196 32 patients committed opioid misuse detection cocaine amphetamines uts common form misuse 403 misusers bivariate analysis misusers likely nonmisusers younger 48 years vs 54 years p 0001 male 596 vs 38 p 0023 past alcohol abuse 44 vs 23 p 0004 past cocaine abuse 68 vs 21 p 0001 previous drug dui conviction 40 vs 11 p 0001 multivariate analyses age past cocaine abuse 43 drug dui conviction 26 past alcohol abuse 26 persisted predictors misuse race income education depression score disability score pain score literacy associated misuse relationship pain scores misuse emergedopioid misuse occurred frequently chronic pain patients pain management program within academic primary care practice patients history alcohol cocaine abuse alcohol drug related convictions carefully evaluated followed signs misuse opioids prescribed structured monitoring opioid misuse potentially ensure appropriate use opioids chronic pain management mitigate adverse public health effects diversion