title: Chronic opioid therapy and preventive services in rural primary care: an Oregon rural practice-based research network study.
abstract: OBJECTIVE
  For clinicians, using opioid therapy for chronic noncancer pain (CNCP) often gives rise to a conflict between treating their patients' pain and fears of addiction, diversion of medication, or legal action. Consequent stresses on clinical encounters might adversely affect some elements of clinical care. We evaluated a possible association between chronic opioid therapy (COT) for CNCP and receipt of various preventive services.
  
  
  METHODS
  We conducted a retrospective cohort study in 7 primary care clinics within the Oregon Rural Practice-based Research Network (ORPRN). Using medical records of 704 patients, aged 35 to 85 years, seen during a 3-year period, we compared the receipt of 4 preventive services between patients on COT for CNCP and patients not on chronic opioid therapy (non-COT). We used multivariate log-binomial regression analyses to estimate the relative risk of receipt of each preventive service.
  
  
  RESULTS
  After adjustment for plausible confounders, we found that patients using COT had a statistically significantly lower relative risk (RR) of receipt of cervical cancer screening (RR = 0.60; 95% confidence interval [CI], 0.47-0.76) and colorectal cancer screening (RR = 0.42; 95% CI, 0.22-0.80) when compared with non-COT patients. The RR was reduced, without statistical significance, for lipid screening (RR = 0.77; 95% CI, 0.54-1.10), and not notably reduced for smoking cessation counseling (RR = 0.95; 95% CI, 0.78-1.15).
  
  
  CONCLUSIONS
  Patients using COT for CNCP were less likely to receive some preventive services. Research is needed to better understand barriers to and improved methods for providing preventive services for these patients.
authors.affiliation: Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. buckleyd@ohsu.edu
authors.forename: David I
authors.initials: DI
authors.lastname: Buckley
authors.forename: James F
authors.initials: JF
authors.lastname: Calvert
authors.forename: Jodi A
authors.initials: JA
authors.lastname: Lapidus
authors.forename: Cynthia D
authors.initials: CD
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002908:Chronic Disease; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008055:Lipids / Q000097:blood; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications; D009922:Oregon; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010342:Patient Acceptance of Health Care; D011315:Preventive Medicine; D011320:Primary Health Care / Q000458:organization & administration*; D012044:Regression Analysis; D012189:Retrospective Studies; D012306:Risk; D019035:Rural Health Services; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D008055:Lipids
references.citation: CMAJ. 2006 May 23;174(11):1589-94
references.pmid: 16717269
references.citation: Med Econ. 2001 Nov 19;78(22):66-8
references.pmid: 11762117
references.citation: Fam Pract. 1991 Sep;8(3):276-87
references.pmid: 1959729
references.citation: South Med J. 2006 Nov;99(11):1245-55
references.pmid: 17195420
references.citation: J Pain. 2009 Feb;10(2):147-59
references.pmid: 19187891
references.citation: Pain. 2004 Sep;111(1-2):51-8
references.pmid: 15327808
references.citation: Am J Epidemiol. 2004 Apr 1;159(7):702-6
references.pmid: 15033648
references.citation: J Am Board Fam Pract. 2001 May-Jun;14(3):211-8
references.pmid: 11355054
references.citation: Lancet. 1999 Oct 9;354(9186):1248-52
references.pmid: 10520633
references.citation: Clin J Pain. 2002 Jul-Aug;18(4 Suppl):S28-38
references.pmid: 12479252
references.citation: Fam Pract. 2004 Feb;21(1):66-74
references.pmid: 14760048
references.citation: Br J Gen Pract. 1992 Nov;42(364):454-8
references.pmid: 1472390
references.citation: Clin J Pain. 2007 Nov-Dec;23(9):799-803
references.pmid: 18075408
references.citation: Curr Med Res Opin. 2005 Oct;21(10):1555-68
references.pmid: 16238895
references.citation: Med Clin North Am. 1999 May;83(3):555-83, v
references.pmid: 10386115
references.citation: Am J Epidemiol. 2005 Aug 1;162(3):199-200
references.pmid: 15987728
references.citation: Arch Phys Med Rehabil. 2008 Mar;89(3 Suppl 1):S72-6
references.pmid: 18295654
references.citation: Pain Med. 2004 Sep;5(3):309-24
references.pmid: 15367312
references.citation: Curr Opin Anaesthesiol. 2007 Oct;20(5):451-5
references.pmid: 17873598
references.citation: J Gen Intern Med. 2002 Mar;17(3):173-9
references.pmid: 11929502
references.citation: Pain Med. 2001 Dec;2(4):317-27
references.pmid: 15102236
references.citation: J Pain Symptom Manage. 2002 Feb;23(2):131-7
references.pmid: 11844633
references.citation: Curr Med Res Opin. 2006 Sep;22(9):1859-65
references.pmid: 16968589
references.citation: Am J Epidemiol. 2003 May 15;157(10):940-3
references.pmid: 12746247
references.citation: Fam Med. 2005 Jul-Aug;37(7):477-80
references.pmid: 15988631
references.citation: Adv Ther. 2000 Mar-Apr;17(2):70-83
references.pmid: 11010058
references.citation: N Engl J Med. 2007 Jun 14;356(24):2496-504
references.pmid: 17568030
references.citation: JAMA. 2003 Nov 12;290(18):2443-54
references.pmid: 14612481
references.citation: Clin Ther. 2007;29 Suppl:2589-602
references.pmid: 18164924
references.citation: Fam Med. 2003 Feb;35(2):119-23
references.pmid: 12607809
references.citation: Pain Med. 2007 Jul-Aug;8(5):433-7
references.pmid: 17661857
references.citation: Am J Manag Care. 2009 Apr;15(4):217-24
references.pmid: 19355794
references.citation: N Engl J Med. 2003 Nov 13;349(20):1943-53
references.pmid: 14614170
references.citation: Pain Med. 2007 Nov-Dec;8(8):647-56
references.pmid: 18028043
references.citation: Pain. 2007 Jun;129(3):233-234
references.pmid: 17449177
references.citation: Pain. 1999 Jul;82(1):89-96
references.pmid: 10422664
references.citation: J Fam Pract. 2004 Oct;53(10 Suppl):S23-32
references.pmid: 15469762
references.citation: J Pain Symptom Manage. 2008 Feb;35(2):214-28
references.pmid: 18178367
references.citation: JAMA. 1998 Nov 18;280(19):1690-1
references.pmid: 9832001
references.citation: J Fam Pract. 2001 Feb;50(2):145-51
references.pmid: 11219563