title: Prescription opioid abuse, chronic pain, and primary care: a Co-occurring Disorders Clinic in the chronic disease model.
abstract: Abuse of opioids has become a public health crisis. The historic separation between the addiction and pain communities and a lack of training in medical education have made treatment difficult to provide, especially in primary care. The Co-occurring Disorders Clinic (COD) was established to treat patients with co-morbid chronic pain and addiction. This retrospective chart review reports results of a quality improvement project using buprenorphine/naloxone to treat co-occurring chronic non-cancer pain (CNCP) and opioid dependence in a primary care setting. Data were collected for 143 patients who were induced with buprenorphine/naloxone (BUP/NLX) between June 2009 and November 2011. Ninety-three patients (65%) continued to be maintained on the medication and seven completed treatment and were no longer taking any opioid (5%). Pain scores showed a modest, but statistically significant improvement on BUP/NLX, which was contrary to our expectations and may be an important factor in treatment retention for this challenging population.
authors.affiliation: Raymond G. Murphy New Mexico Veterans' Affairs Health Care System, Albuquerque, NM 87108, USA. patricia.pade@va.gov
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pade
authors.forename: Karen E
authors.initials: KE
authors.lastname: Cardon
authors.forename: Richard M
authors.initials: RM
authors.lastname: Hoffman
authors.forename: Cynthia M A
authors.initials: CM
authors.lastname: Geppert
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002047:Buprenorphine / Q000008:administration & dosage / Q000627:therapeutic use*; D000069479:Buprenorphine, Naloxone Drug Combination; D059350:Chronic Pain / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000150:complications / Q000534:rehabilitation*; D010147:Pain Measurement; D055553:Prescription Drugs / Q000009:adverse effects; D011320:Primary Health Care / Q000458:organization & administration; D058996:Quality Improvement; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000069479:Buprenorphine, Naloxone Drug Combination; D009292:Narcotic Antagonists; D055553:Prescription Drugs; D009270:Naloxone; D002047:Buprenorphine