title: History of drug use predicts opioid treatment agreement violation.
abstract: OBJECTIVE
  To determine reasons and describe characteristics of patients who violate their opioid treatment agreement.
  
  
  METHODS
  Cross-sectional retrospective study.
  
  
  METHODS
  New patients aged 18 years or above attending a multidisciplinary comprehensive pain management clinic from January 2012 to June 2012.
  
  
  METHODS
  Reason for discharge from the clinic.
  
  
  RESULTS
  Of the 234 subjects in the study, 38.5 percent were discharged due to treatment agreement violation. A majority had a self-reported history of tobacco use, followed by alcohol and marijuana. The mean age of discharge was 45.1 years (SD 11.6) and they were discharged on average in 7.4 months after their first clinic visit. The primary reason for discharge was for an inappropriate urine drug screen (UDS) with illicit drug use being the most common at 40 percent and marijuana being the most common illicit drug. Subjects reporting a history of any drug use were nearly seven times more likely to be discharged. Hydrocodone was the most common nonprescribed opioid found in the UDS for those discharged for using nonprescribed opioids.
  
  
  CONCLUSIONS
  Inappropriate UDS is a main factor for discharge due to violation of the opioid treatment agreement. Those with self-reported current or prior drug use were more likely to be discharged from the clinic.
authors.affiliation: PM&R Resident, Eastern Virginia Medical School, Norfolk, Virginia.
authors.forename: Pamela
authors.initials: P
authors.lastname: Summers
authors.affiliation: Faculty Advisor, Eastern Virginia Medical School, Norfolk, Virginia.
authors.forename: Brook
authors.initials: B
authors.lastname: Alemu
authors.affiliation: Chair, PM&R, Eastern Virginia Medical School, Norfolk, Virginia.
authors.forename: Antonio
authors.initials: A
authors.lastname: Quidgley-Nevares
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000652:urine; D010349:Patient Compliance; D012189:Retrospective Studies; D057566:Self Report; D015813:Substance Abuse Detection