title: Nonopioid substance use disorders and opioid dose predict therapeutic opioid addiction.
abstract: Limited research examines the risk of therapeutic opioid addiction (TOA) in patients with chronic noncancer pain. This study examined TOA among 199 patients undergoing long-term opioid therapy at the time of admission to a pain rehabilitation program. It was hypothesized that nonopioid substance use disorders and opioid dosage would predict TOA. Daily mean opioid dose was 132.85 mg ± 175.39. Patients with nonopioid substance use disorders had 28 times the odds (odds ratio [OR] = 28.58; 95% confidence interval [CI] = 10.86, 75.27) of having TOA. Each 50-mg increase in opioid dose nearly doubled the odds of TOA (OR = 1.73; 95% CI = 1.29, 2.32). A 100-mg increase was associated with a 3-fold increase in odds (OR = 3.00; 95% CI = 1.67, 5.41). Receiver operating characteristic analysis revealed that opioid dose was a moderately accurate predictor (area under the curve = .75; 95% CI = .68, .82) of TOA. The sensitivity (.70) and specificity (.68) of opioid dose in predicting TOA was maximized at 76.10 mg; in addition, 46.00 mg yielded 80% sensitivity in identifying TOA. These results underscore the importance of obtaining a substance use history prior to prescribing and suggest a low screening threshold for TOA in patients who use opioids in the absence of improvement in pain or functional impairment.
  
  
  CONCLUSIONS
  This article examines TOA in patients with chronic noncancer pain undergoing long-term opioid therapy. Results suggest that patients should be screened for nonopioid substance use disorders prior to prescribing. In the absence of improvement in pain or function, there is a low threshold (∼50 mg daily opioid dose) for addiction screening.
authors.affiliation: Cleveland Clinic Neurological Center for Pain, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio. Electronic address: huffmak3@ccf.org.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Huffman
authors.affiliation: Cleveland Clinic Neurological Center for Pain, Cleveland, Ohio.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Shella
authors.affiliation: Cleveland Clinic Neurological Center for Pain, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
authors.forename: Giries
authors.initials: G
authors.lastname: Sweis
authors.affiliation: Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, Ohio.
authors.forename: Sandra D
authors.initials: SD
authors.lastname: Griffith
authors.affiliation: Cleveland Clinic Neurological Center for Pain, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
authors.forename: Judith
authors.initials: J
authors.lastname: Scheman
authors.affiliation: Cleveland Clinic Neurological Center for Pain, Cleveland, Ohio.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Covington
mesh_terms: D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000009:adverse effects*; D059350:Chronic Pain / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000209:etiology* / Q000628:therapy*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid
keywords: Long-term opioid therapy; chronic pain; opioid dosage; substance abuse; therapeutic opioid addiction