Predictors of resolution of aberrant drug behavior in chronic pain patients treated in a structured opioid risk management program.
OBJECTIVE
To identify demographic and clinical predictors of the resolution of aberrant drug-related behaviors (ADRBs) in a group of patients referred to the Opioid Renewal Clinic (ORC) by their primary care providers (PCPs). ORC is a program supporting PCPs' use of opioids for chronic pain in patients perceived as at risk for opioid abuse or those with demonstrated ADRBs.


METHODS
A retrospective chart review was conducted for 195 consecutive subjects referred to the ORC from January 17, 2002 to August 27, 2004, for ADRBs. Binary logistic regression was employed to identify independent predictors of aberrant behavior outcome at 1 year.


RESULTS
Of the 195 referred, 45.6% (N = 89) resolved their ADRB at 1 year. Other outcomes, classified as nonresolution of ADRB, self-discharged or discharged by the ORC for inability to adhere to the opioid treatment agreement (N = 86, 44.1%) and acceptance of referral for addiction treatment (N = 20, 10.2%). A history of cocaine abuse increased the odds of failing the program by five times (odds ratio [OR] = 4.97, P = 0.001). Each additional pain diagnosis reduced the odds of failure by 16% (OR = 0.837, P = 0.008). When compared with singles, married individuals were 62% less likely to fail the ORC program (OR = 0.38, P = 0.028).


CONCLUSIONS
Nearly half of the patients resolved their aberrant behavior within the ORC. Patients with cocaine abuse were at higher risk for failure, suggesting a need for further research into safe and effective ways to manage pain in this complex subset of patients. Aberrant behaviors tended to resolve in patients with multiple pain locations, possibly because of their desire for relief.
Meghani
Salimah H
SH
NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Pennsylvania, USA.
Wiedemer
Nancy L
NL
Becker
William C
WC
Gracely
Ed J
EJ
Gallagher
Rollin M
RM
D000701:Analgesics, Opioid; D001569:Benzodiazepines; D002908:Chronic Disease; D019970:Cocaine-Related Disorders / Q000150:complications / Q000523:psychology; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology / Q000523:psychology; D008875:Middle Aged; D016017:Odds Ratio; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000523:psychology*; D010146:Pain / Q000150:complications* / Q000523:psychology*; D018710:Pain Clinics / Q000458:organization & administration*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012308:Risk Management / Q000379:methods*; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D001569:Benzodiazepines