Psychological factors as predictors of opioid abuse and illicit drug use in chronic pain patients

Background: Psychopathology (depression, anxiety, somatization disorder) and substance abuse (opioid mis-use and illicit drug use) are common in patients with chronic pain and present problems for public health and clinical management. Despite a body of literature describing various methods for identifying psychopathology, opioid misuse, and illicit drug use in chronic pain patients, the relationship between psychopathologies, substance abuse, and chronic pain has not been well characterized.Methods: This report describes a total of500 consecutive pain patients prescribed and receiving stable doses of opioids. The patients were evaluated for psychopathology, opioid abuse, and illicit drug use during the course of regular pain management treatment. The relationships between psychopathology and drug abuse and/or illicit drug use in chronic pain patients were examined, and psychological evaluation for depression, anxiety, and somatization disorder was performed.Results: Depression, anxiety, and somatization disorder were documented in 59, 64, and 30percent of chronic pain patients, respectively. Drug abuse was significantly higher in patients with depression as compared to patients without depression (12percent with depression versus 5percent without). Current illicit drug use was higher in women with depression (22 percent) than women without depression (14percent) and in men with or without depression (12percent). Current illicit drug use was also higher in men with somatization disorder (22 percent) than men without (9 percent).Conclusion: This study demonstrated that the presence of psychological features of depression and somatization disorder may be markers of substance abuse diathesis in chronic pain patients.

Download Full-text

The SISAP: A New Screening Instrument for Identifying Potential Opioid Abusers in the Management of Chronic Nonmalignant Pain Within General Medical Practice

Pain Research and Management ◽

10.1155/1996/391248 ◽

1996 ◽

Vol 1 (3) ◽

pp. 155-162 ◽

Cited By ~ 50

Author(s):

Robert B Coambs ◽

Josée L Jarry ◽

Anusha C Santhiapillai ◽

Rixi V Abrahamsohn ◽

Cristina M Atance

Keyword(s):

Substance Abuse ◽

Chronic Pain ◽

Drug Use ◽

Illicit Drug ◽

Substance Abusers ◽

Opioid Analgesics ◽

Illicit Drug Use ◽

Screening Instrument ◽

Prior History ◽

History Of

BACKGROUND:Many physicians are overly cautious about prescribing opioids for chronic pain because of fears of iatrogenic addiction. However, in patients with chronic pain, addiction to opioid analgesics is exceedingly rare when there is no prior history of alcohol or drug abuse.OBJECTIVE:To validate an instrument that separates possible opioid abusers from those who are at low risk.DESIGN/METHODS:The Screening Instrument for Substance Abuse Potential (SISAP) was designed to identify individuals with a possible substance abuse history quickly and accurately. It is based on the National Alcohol and Drug Use Survey (n=9915). Using the first half of the sample (n=4967), two previously validated alcohol use items were combined with three illicit drug use items. These five questions identified those with a history of alcohol and/or illicit drug use.RESULTS:Using the second half of the sample (n=4948), the validation procedure showed that the five combined items correctly classified 91% of substance abusers and had a low rate of false negatives.DISCUSSION:The SISAP is brief and resistant to misrepresentation or falsification. The SISAP is expected to improve pain management by facilitating focus on the appropriate use of opioid analgesics and therapeutic outcomes in the majority of patients who are not at risk of opioid abuse, while carefully monitoring those who may be at greater risk.

Download Full-text