Aberrant behaviors in a primary care-based cohort of patients with chronic pain identified as misusing prescription opioids

Abstract

To assess aberrant drug-related behaviors (ADRBs) in patients discharged from a community primary care practice for opioid misuse and treating physician's ability to identify predictive aberrant behaviors. Retrospective chart review of patients with chronic noncancer pain (CNCP) identified by their treating physician as misusing opioid analgesics, and patients with similar characteristics who had not been identified as misusing opioids. A survey of attending and resident physicians from these clinics on their knowledge of ADRBs was also collected. Community primary care clinic. Thirty-three patients with CNCP identified by their treating physician as misusing prescription opioid analgesics, and 33 patients randomly selected from the same clinic setting, with similar characteristics who had not been identified as misusing opioids. Twenty-four attending physicians and 42 resident physicians were surveyed on their training and knowledge of predictive aberrant behaviors. More identified misusers than nonmisusers reported positive history of substance abuse (p=0.001), tobacco use (p=0.011), taking multiple doses of prescribed opioids together (0.024), multiple complaints of pain requiring opioid treatment (p=0.006), and multiple phone calls to the clinic requesting opioid medications (p=0.027). Logistic regression on continuous variables revealed that only the number of phone calls to the clinic regarding opioids in the last 12 months achieved significance (p=0.028). Previously postulated and novel ADRBs suggestive of opioid misuse were identified in a community primary care setting. Differences in resident and attending physician's ability to identify key predictive ADRBs and lack of training in pain or addiction underscores the need for changes in medical school and residency programs.