Chronic opioid therapy for nonmalignant pain in patients with a history of substance abuse: Report of 20 cases

• Published in: Journal of pain and symptom management Vol. 11; no. 3; pp. 163 - 171
• Main Authors: Dunbar, Stuart A., Katz, Nathaniel P.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.1996; Elsevier Science
• Subjects: Adult; Analgesics; Analgesics, Opioid - therapeutic use; Biological and medical sciences; Chronic Disease; chronic opioid therapy; Female; Humans; Male; Medical sciences; Middle Aged; Neuropharmacology; Nonmalignant pain; Pain - complications; Pain - drug therapy; Pharmacology. Drug treatments; substance abuse; Substance-Related Disorders - complications; chronic opioid therapy; substance abuse; Nonmalignant pain; Human; Drug addiction; Chemotherapy; Pain; Treatment; Opiates; Narcotic analgesic; Long term
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/0885-3924(95)00165-4

A history of substance abuse is considered by many to be a contraindication to chronic opioid therapy for nonmalignant pain. Twenty patients with a history of chronic nonmalignant pain and substance abuse treated with chronic opioid therapy for a period of more than 1 year were retrospectively evaluated to determine the factors associated with prescription abuse. The prevalence of six aberrant behavioral patterns was assessed to see if these correlated with a history of prescription abuse, as reported by the patient's pain clinic physician. Those who did not abuse opioid therapy were more likely to have a history of alcohol abuse alone or a remote history of polysubstance abuse. They were also more likely to be active members of Alcoholics Anonymous and to have a stable family or other similar support system. In contrast, those who abused opioid therapy showed characteristic aberrant patterns of behavior in their management, which indicated a clear pattern of prescription abuse early in the course of therapy. Those patients were more likely to be recent polysubstance abusers, or have a prior history of oxycodone abuse. None of them were active members of Alcoholics Anonymous. Signing an “opioids contract” was not in and of itself a predictor of successful outcome.