***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Opioid misuse can complicate chronic pain management , and the non-medical use of opioids is a growing public health problem . The incidence and risk factors for opioid misuse in patients with chronic pain , however , have not been well characterized . We conducted a prospect i ve cohort study to determine the one-year incidence and predictors of opioid misuse among patients enrolled in a chronic pain disease management program within an academic internal medicine practice . Methods One-hundred and ninety-six opioid-treated patients with chronic , non-cancer pain of at least three months duration were monitored for opioid misuse at pre-defined intervals . Opioid misuse was defined as : 1 . Negative urine toxicological screen ( UTS ) for prescribed opioids ; 2 . UTS positive for opioids or controlled substances not prescribed by our practice ; 3 . Evidence of procurement of opioids from multiple providers ; 4 . Diversion of opioids ; 5 . Prescription forgery ; or 6 . Stimulants ( cocaine or amphetamines ) on UTS . Results The mean patient age was 52 years , 55 % were male , and 75 % were white . Sixty-two of 196 ( 32 % ) patients committed opioid misuse . Detection of cocaine or amphetamines on UTS was the most common form of misuse ( 40.3 % of misusers ) . In bivariate analysis , misusers were more likely than non-misusers to be younger ( 48 years vs 54 years , p < 0.001 ) , male ( 59.6 % vs. 38 % ; p = 0.023 ) , have past alcohol abuse ( 44 % vs 23 % ; p = 0.004 ) , past cocaine abuse ( 68 % vs 21 % ; p < 0.001 ) , or have a previous drug or DUI conviction ( 40 % vs 11 % ; p < 0.001 % ) . In multivariate analyses , age , past cocaine abuse ( OR , 4.3 ) , drug or DUI conviction ( OR , 2.6 ) , and a past alcohol abuse ( OR , 2.6 ) persisted as predictors of misuse . Race , income , education , depression score , disability score , pain score , and literacy were not associated with misuse . No relationship between pain scores and misuse emerged . Conclusion Opioid misuse occurred frequently in chronic pain patients in a pain management program within an academic primary care practice . Patients with a history of alcohol or cocaine abuse and alcohol or drug related convictions should be carefully evaluated and followed for signs of misuse if opioids are prescribed . Structured monitoring for opioid misuse can potentially ensure the appropriate use of opioids in chronic pain management and mitigate adverse public health effects of diversion A r and om sample of 1,200 employees of a steel manufacturing plant were r and omly assigned to four different self-report methods of assessing illicit drug use : 1 ) Individual interview in the workplace , 2 ) group-administered question naire in the workplace , 3 ) telephone interview , and 4 ) individual interview off the worksite .  Urine specimens were collected and analyzed on all 928 subjects participating in the study , and hair analysis was conducted on 307 of the subjects . Although self-reports produced the highest drug use prevalence rate , analyses combining the results of the three assessment methods showed that the actual prevalence rate was approximately 50 % higher than the estimate produced by self-reports . The group-administered question naire condition produced prevalence rates that were roughly half those of the other self-report methods . The findings cast doubt on the validity of self-reports as a means of estimating drug use prevalence and suggest the need for multiple assessment methods Objective To examine the incidence of abnormal urine toxicology screening among chronic pain patients prescribed opioids for their pain and to relate these results to patient descriptors and type , number , and dose of prescribed opioids . Methods A retrospective analysis of data from 470 patients who had urine screening at a pain management program in an urban teaching hospital was performed . Urine sample s were analyzed using gas chromatography-mass spectrometry .  Patients were categorized as having urine screens that were “ normal ” ( expected findings based on their prescribed drugs ) or abnormal . Abnormal findings were those of ( 1 ) absence of a prescribed opioid , ( 2 ) presence of an additional nonprescribed controlled substance , ( 3 ) detection of an illicit substance , and ( 4 ) an adulterated urine sample . Results Forty-five percent of the patients were found to have abnormal urine screens . Twenty percent were categorized as having an illicit substance in their urine . Illicit substances and additional drugs were found more frequently in younger patients than in older patients ( P<0.001 ) . No other variables were found to predict abnormal urine screen results . Discussion These results confirm past findings that r and om urine toxicology screens among patients prescribed opioids for pain reveal a high incidence of abnormal findings . Common patient descriptors , and number , type , and dose of prescribed opioids were found to be poor predictors of abnormal results This study introduces the  Addiction Behaviors Checklist  ( ABC ) , which is a brief ( 20-item ) instrument design ed to track behaviors characteristic of addiction related to prescription opioid medications in chronic pain population s. Items are focused on observable behaviors noted both during and between clinic visits . One hundred thirty-six consecutive veterans in a multidisciplinary Veterans Affairs Chronic Pain Clinic who were receiving long-term opioid medication treatment were included in this study . This study represents one of the first to follow a sample of chronic pain patients on opioid therapy over time , using a structured assessment tool to evaluate and track behaviors suggestive of addiction . Interrater reliability and concurrent validity data are presented , as well as a cut-off score for use in determining inappropriate medication use . The psychometric findings support the ABC as a viable assessment tool that can increase a provider 's confidence in determinations of appropriate vs. inappropriate opioid use & NA ; Prescribing long‐term opioids for patients with chronic pain is controversial . The primary purpose of this study was to examine physicians ' beliefs about and prescribing of the long‐term use of opioids in the treatment of chronic pain patients . Concerns about regulatory pressure and appropriateness of education regarding opioids were also examined . The design was a stratified r and om sample . In the United States , 6962 physicians were r and omly selected from two states in each of five regions of the country ( Northeast , Midwest , Southeast , Southwest , and Pacific ) . Physicians from seven medical specialties ( Family Practice , Internal Medicine , Physical Medicine and Rehabilitation , Rheumatology , Orthopedic Surgery , Neurosurgery , and Neurology ) were surveyed and 1912 ( 27.46 % ) responded . A survey consisting of questions regarding years of practice , number of chronic pain patients treated , frequency of prescribing long‐term opioids , concerns about opioids , goals of treatment , beliefs about education regarding opioids , and concerns about regulatory pressures  was used . Based on the physicians who responded , it appears that prescription of long‐term opioids is relatively wide‐spread . Differences were noted by region , specialty , and the requirement for the use of multiple prescriptions for schedule II drugs . Physicians in the Midwestern United States were the least likely to prescribe the long‐term use of opioids . Rheumatologists and general practitioners were significantly more likely to prescribe  long‐term opioids  than were surgeons , neurologists , or physiatrists and were more likely to emphasize the importance of symptom improvement as an appropriate goal even in the absence of functional improvements . The majority of the respondents expressed relatively little concern about tolerance , dependence , and addiction as impediments to prescribing opioids . Physicians from states requiring multiple prescriptions reported that this legal requirement had little impact on their practice Abstract OBJECTIVES : To define the spectrum of chronic noncancer pain treated with opioid medications  in 2 primary care setting s , and the prevalence of psychiatric comorbidity in this patient population . We also sought to determine the proportion of patients who manifested prescription opioid abuse behaviors and the factors associated with these behaviors . DESIGN : A retrospective cohort study . SETTING : A VA primary care clinic and an urban hospital-based primary care center ( PCC ) located in the northeastern United States . PATIENTS : A r and om sample of VA patients ( n=50 ) and all PCC patients ( n=48 ) with chronic noncancer pain who received 6 or more months of opioid prescriptions during a 1-year period ( April 1 , 1997 through March 31 , 1998 ) and were not on methadone maintenance .  MEASUREMENTS : Information regarding patients ’ type of chronic pain disorder , demographic , medical , and psychiatric status , and the presence of prescription opioid abuse behaviors was obtained by medical record review . MAIN RESULTS : Low back pain was the most common disorder accounting for 44 % and 25 % of all chronic pain diagnoses in the VA and PCC sample s , respectively , followed by injury-related ( 10 % and 13 % ) , diabetic neuropathy ( 8 % and 10 % ) , degenerative joint disease ( 16 % and 13 % ) , spinal stenosis ( 10 % and 4 % ) , headache ( 4 % and 13 % ) and other chronic pain disorders ( 8 % and 22 % ) . The median duration of pain was 10 years ( range 3 to 50 years ) in the VA and 13 years in the PCC sample ( range 1 to 49 years ) . Among VA and PCC patients , the lifetime prevalence rates of psychiatric comorbidities were : depressive disorder ( 44 % and 54 % ) , anxiety disorder ( 20 % and 21 % ) , alcohol abuse/dependence ( 46 % and 31 % ) , and narcotic abuse/dependence ( 18 % and 38 % ) . Prescription opioid abusive behaviors were recorded for 24 % of VA and 31 % of PCC patients . A lifetime history of a substance use disorder ( adjusted odds ratio [ OR ] , 3.8 ; 95 % confidence interval [ CI ] , 1.4 to 10.8 ) and age ( adjusted OR , 0.94 ; 95 % CI , 0.89 to 0.99 ) were independent predictors of prescription opioid abuse behavior . CONCLUSIONS : A broad spectrum of chronic noncancer pain disorders are treated with opioid medications in primary care setting s. The lifetime prevalence of psychiatric comorbidity was substantial in our study population . A significant minority of patients manifested prescription opioid abusive behaviors , and a lifetime history of a substance use disorder and decreasing age were associated with prescription opioid abuse behavior . Prospect i ve studies are needed to determine the potential benefits as well as risks associated with opioid use for chronic noncancer pain in primary care OBJECTIVE To provide clinicians with a brief screening tool to predict accurately which individuals may develop aberrant behaviors when prescribed opioids for chronic pain . DESIGN One hundred and eighty-five consecutive new patients treated in one pain clinic took the self-administered Opioid Risk Tool ( ORT ) . The ORT measured the following risk factors associated in scientific literature with substance abuse : personal and family history of substance abuse ; age ; history of preadolescent sexual abuse ; and certain psychological diseases . Patients received scores of 0 - 3 ( low risk ) , 4 - 7 ( moderate risk ) , or > or= 8 ( high risk ) , indicating the probability of their displaying opioid-related aberrant behaviors . All patients were monitored for aberrant behaviors for 12 months after their initial visits . RESULTS For those patients with a risk category of low , 17 out of 18 ( 94.4 % ) did not display an aberrant behavior . For those patients with a risk category of high , 40 out of 44 ( 90.9 % ) did display an aberrant behavior . The authors used the c statistic to vali date the ORT , because it simultaneously assesses sensitivity and specificity . The ORT displayed excellent discrimination for both the male ( c = 0.82 ) and the female ( c = 0.85 ) prognostic models . CONCLUSION In a preliminary study , among patients prescribed opioids for chronic pain , the ORT exhibited a high degree of sensitivity and specificity for determining which individuals are at risk for opioid-related , aberrant behaviors . Further studies in a variety of pain and nonpain setting s are needed to determine the ORT 's universal applicability Assessing for the presence of addiction in the chronic pain patient receiving chronic opioid analgesia is a challenging clinical task . This paper presents a recently developed screening tool for addictive disease in chronic pain patients , and pilot efficacy data describing its ability to do so . In a small sample of patients ( n = 52 ) referred from a multidisciplinary pain center for " problematic " medication use , responses to the screening question naire were compared between patients who met combined diagnostic criteria for a substance use disorder and those who did not , as assessed by a trained addiction medicine specialist . Responses of addicted patients significantly differed from those of nonaddicted patients on multiple screening items , with the two groups easily differentiated by total question naire score . Further , three key screening indicators were identified as excellent predictors for the presence of addictive disease in this sample of chronic pain patients OBJECTIVES Opiates are commonly used to treat patients with chronic nonmalignant pain . There is much controversy over the definition , incidence , and risk factors of prescription opiate abuse in chronic pain treatment . The present study , done at the Seattle VA Medical Center , was design ed to create opiate abuse criteria , 
    Output:
    
Review of the published studies reveals that no one procedure or set of predictor variables is sufficient to identify CPP at-risk for opioid misuse or abuse .
Strong predictors include a personal history of illicit drug and alcohol abuse .