Patterns of illicit drug use and opioid abuse in patients with chronic pain at initial evaluation: a prospective, observational study

Over the years, there has been a shift toward the increased reliance on opioids for the treatment of chronic pain. It is well known that some patients do not provide an appropriate history or underestimate their drug intake, and may exaggerate reported pain levels. Numerous studies have documented the incidence of illicit drug use and abuse of opioids in chronic pain patients. It is not known what proportion of patients have already been exposed to controlled substances prior to presenting for interventional pain management.

To evaluate and identify the prevalence of controlled substance use, demographic characteristics, and psychological characteristics of patients presenting for interventional pain management along with illicit drug use.

A prospective, observational study.

A total of 100 patients presenting at an interventional pain management setting for initial evaluation were evaluated by detailed history and urine drug testing for controlled substance use and illicit drug use.

Duration of pain on average was 9.3 years, 57% of the patients had involvement of more than one body region, 90% were taking opioids, 47% had been seen by 5 or more providers, and more than 70% presented with psychological problems. Twenty-three patients tested positive for illicit drugs and 12 patients were positive for opioids even though they had no prescription and denied taking opioids. Twenty-seven patients either under-reported (16) or over-reported (11) opioid use.

Ninety percent of these patients were taking opioids. Twenty-seven patients incorrectly reported opioid use, either underuse or overuse, with 23 patients using illicit drugs, 12 using non-prescription opioids, and with 35 of 100 patients at initial evaluation exhibiting one of the abuse behaviors.