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Substance Use Disorders in a Primary Care Sample Receiving Daily Opioid Therapy

Fleming, M.F.; Balousek, S.L.; Klessig, C.L.; Mundt, M.P.; Brown, D.P.; Journal of Pain; 8(7): 573-582; 2007-07. Posted: 2007-08-12, Modified: 2007-08-13.
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Alex DeLuca; War on Docs/Pain Crisis; 2007-08-12
Red Flags and the Standard of Care; DeLuca; 2007
Interpretation of Aberrant Drug-Related Behaviors; Frank Fisher; 2004
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The primary goal of this paper was to present a comprehensive picture of substance use disorders in a sample of patients receiving opioid therapy from their primary care physician. A second goal was to determine the relation of positive urine screens and aberrant drug behaviors to opioid use disorders. The study recruited 801 adults receiving daily opioid therapy from the primary care practices of 235 family physicians and internists in 6 health care systems in Wisconsin. The 6 most common pain diagnoses were degenerative arthritis, low back pain, migraine headaches, neuropathy, and fibromyalgia. The point prevalence of current (DSM-IV criteria in the past 30 days) substance abuse and/or dependence was 9.7% (n = 78) and 3.8% (30) for an opioid use disorder. A logistic regression model found that current substance use disorders were associated with age between 18 and 30 (OR = 6.17: 1.99 to 19.12), severity of lifetime psychiatric disorders (OR = 6.17; 1.99 to 19.12), a positive toxicology test for cocaine (OR = 5.92; 2.60 to 13.50) or marijuana (OR = 3.52; 1.85 to 6.73), and 4 aberrant drug behaviors (OR = 11.48; 6.13 to 21.48). The final model for opioid use disorders was limited to aberrant behaviors (OR = 48.27; 13.63 to 171.04) as the other variables dropped out of the model.

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Originally posted: 2007-08-12

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