***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Summary An intricate relationship between chronic pain , opioid use and addictive behaviors was demonstrated , and certain addictive behaviors seem to predict or be associated with opioid use in chronic non‐cancer pain . Abstract The growing body of research showing increased opioid use in patients with chronic pain coupled with concerns regarding addiction encouraged the development of this population ‐based study . The goal of the study was to investigate the co‐occurrence of indicators of addictive behaviors in patients with chronic non‐cancer pain in long‐term opioid treatment . The study combined data from the  individual‐based Danish Health Survey in 2010 and the official Danish health and socio‐economic , individual‐based registers . From a simple r and om sample of 25,000 adults ( 16 years or older ) living in Denmark , 13,281 individuals were analyzed through multiple logistic regression analyses to assess the association between chronic pain ( lasting ≥6 months ) , opioid use , health behavior , and body mass index . Six potential addictive behaviors were identified : daily smoking ; high alcohol intake ; illicit drug use in the past year ; obesity ; long‐term use of benzodiazepines ; and long‐term use of benzodiazepine‐related drugs . At least 2 of the 6 addictive behaviors were observed in 22.6 % of the long‐term opioid users with chronic pain compared with 11.5 % of the non‐opioid users with chronic pain and 8.9 % of the individuals without chronic pain . Thus , a strong association was demonstrated between long‐term opioid use and the clustering of addictive behaviors . An intricate relationship between chronic pain , opioid use , and addictive behaviors was observed in this study , which deserves both clinical attention and further research AIMS To test ( 1 ) whether abstinence and reduction in illicit psychoactive drug use  were associated with changes in health outcomes in primary care patients and ( 2 ) whether these associations varied by drug type . DESIGN Secondary analysis of data from a r and omized controlled trial that tested a brief intervention for drug use in primary care patients ( 589 enrolled , 574 completed a 6-month assessment ) . Analyses were conducted overall and stratified by the most commonly self-identified main drugs ( marijuana , cocaine and opioids ) . SETTING AND PARTICIPANTS Patients who screened positive for illicit drug use at an urban primary care clinic in Boston , Massachusetts , USA . MEASUREMENTS Differences in past-month main drug use at baseline and 6-month outcome were categorized as continued or increased use , decreased use without abstinence and abstinence . Primary outcomes were 6-month changes in drug use consequences [ Short Inventory of Problems scores ( range 0 - 45 ) ] , depressive symptoms and health-related quality of life ( HRQol ) . FINDINGS  Abstinence  was associated with a greater decrease in adverse drug use consequences than continued or increased use among the full sample and cocaine and opioids subgroups ( adjusted means , full sample : -8.11 versus -0.05 , P < 0.001 ; cocaine : -13.33 versus + 1.09 , P < 0.001 , opioids ; -16.84 versus -2.10 , P < 0.001 ) . Differences were not significant between those who decreased use compared with those who continued or increased use . There were no significant associations between drug use and depressive symptoms or HRQol . Neither abstinence nor decreased use was associated significantly with consequences in the marijuana subgroup . CONCLUSIONS Among primary care patients in the United States who use illicit psychoactive drugs , abstinence but not reduction in use without abstinence appears to be associated with decreased adverse drug use consequences 
    Output:
    
The reporting of this protocol follows the PRISMA -P. Discussion We expect that this review will help determine whether patients that were initially exposed to opioids through a prescription differ in  OST treatment outcomes in comparison to people who used opioids through illicit means .