title: Substance use disorders in a primary care sample receiving daily opioid therapy.
abstract: 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.
  
  
  CONCLUSIONS
  This study found that the frequency of opioid use disorders was 4 times higher in patients receiving opioid therapy compared with general population samples (3.8% vs 0.9%). The study also provides quantitative data linking aberrant drug behaviors to opioid use disorders.
authors.affiliation: Department of Family Medicine, University of Wisconsin, Madison, Wisconsin 53715, USA. mfleming@fammed.wisc.edu
authors.forename: Michael F
authors.initials: MF
authors.lastname: Fleming
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Balousek
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Klessig
authors.forename: Marlon P
authors.initials: MP
authors.lastname: Mundt
authors.forename: David D
authors.initials: DD
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D015984:Causality; D002908:Chronic Disease / Q000628:therapy; D019970:Cocaine-Related Disorders / Q000453:epidemiology; D015897:Comorbidity; D004334:Drug Administration Schedule; D006801:Humans; D016015:Logistic Models; D002189:Marijuana Abuse / Q000453:epidemiology; D008403:Mass Screening; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D010148:Intractable Pain / Q000188:drug therapy*; D010821:Physicians, Family / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D016482:Urinalysis / Q000706:statistics & numerical data
chemical_list: D000701:Analgesics, Opioid