title: Psychological comorbidities predicting prescription opioid abuse among patients in chronic pain presenting to the emergency department.
abstract: OBJECTIVE
  We attempted to identify psychological comorbidities that are associated with the propensity for prescription opioid abuse.
  
  
  METHODS
  Patients presenting to an emergency department seeking opioid refills for chronic pain were evaluated with five validated self-report instruments and structured clinical interviews. The potential for prescription opioid abuse was modeled with multiple regression analysis using depression, anxiety disorders, personality disorder, and addiction as independent variables.
  
  
  RESULTS
  Of the 113 patients studied, 91 (81%) showed a propensity for prescription opioid abuse as determined by scores on the Screener and Opioid Assessment for Patients with Pain instrument. Depression, anxiety, and a history of substance were common and panic attacks, posttraumatic stress disorder, and personality disorders were also found, albeit less frequently. Panic attacks, trait anxiety, and the presence of a personality disorder accounted for 38% of the variance in the potential for prescription opioid abuse.
  
  
  CONCLUSIONS
  Patients in chronic pain should be assessed for psychological and addiction disorders because they are at increased risk for abusing opioids. They should also be referred for psychosocial treatment as part of their care, where appropriate.
authors.affiliation: Department of Anesthesiology and Pain Medicine, and VA Northern California Health Care System, University of California, Davis, CA, USA.
authors.forename: Barth L
authors.initials: BL
authors.lastname: Wilsey
authors.forename: Scott M
authors.initials: SM
authors.lastname: Fishman
authors.forename: Alexander
authors.initials: A
authors.lastname: Tsodikov
authors.forename: Christine
authors.initials: C
authors.lastname: Ogden
authors.forename: Ingela
authors.initials: I
authors.lastname: Symreng
authors.forename: Amy
authors.initials: A
authors.lastname: Ernst
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000503:physiopathology / Q000523:psychology; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000503:physiopathology / Q000523:psychology*; D010146:Pain / Q000188:drug therapy / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid