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Adherence to Clinical Guidelines for Opioid Therapy for Chronic Pain in Patients with Substance Use Disorder

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Abstract

BACKGROUND

Patients with chronic non-cancer pain (CNCP) have high rates of substance use disorders (SUD). SUD complicates pain treatment and may lead to worse outcomes. However, little information is available describing adherence to opioid treatment guidelines for CNCP generally, or guideline adherence for patients with comorbid SUD.

OBJECTIVE

Examine adherence to clinical guidelines for opioid therapy over 12 months, comparing patients with SUD diagnoses made during the prior year to patients without SUD.

DESIGN

Cohort study.

PARTICIPANTS

Administrative data were collected from veterans with CNCP receiving treatment within a Veterans Affairs regional healthcare network who were prescribed chronic opioid therapy in 2008 (n = 5814).

KEY RESULTS

Twenty percent of CNCP patients prescribed chronic opioid therapy had a prior-year diagnosis of SUD. Patients with SUD were more likely to have pain diagnoses and psychiatric comorbidities. In adjusted analyses, patients with SUD were more likely than those without SUD to have had a mental health appointment (29.7% versus 17.2%, OR = 1.49, 95% CI = 1.26–1.77) and a urine drug screen (UDS) (47.0% versus 18.2%, OR = 3.53, 95% CI = 3.06–4.06) over 12 months. There were no significant differences between groups on receiving more intensive treatment in primary care (63.4% versus 61.0%), long-acting opioids (26.9% versus 26.0%), prescriptions for antidepressants (88.2% versus 85.8%, among patients with depression), or participating in physical therapy (30.6% versus 28.6%). Only 35% of patients with SUD received substance abuse treatment.

CONCLUSIONS

CNCP patients with SUD were more likely to have mental health appointments and receive UDS monitoring, but not more likely to participate in other aspects of pain care compared to those without SUD. Given data suggesting patients with comorbid SUD may need more intensive treatment to achieve improvements in pain-related function, SUD patients may be at high risk for poor outcomes.

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Acknowledgments

This study was supported in part by award K23DA023467 from the National Institute on Drug Abuse to Dr. Morasco. Jonathan Duckart, MPS, was supported by grant REA 06–174 from the VA Health Services Research and Development service. The authors appreciate support provided from the Oregon Clinical and Translational Research Institute, grant number Ul1RR024140 from the National Center for Research Resources, a component of the National Institutes of Health and NIH Roadmap for Medical Research. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Health or the Department of Veterans Affairs.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Mental Health and Clinical Neurosciences Division, Portland VA Medical Center, Department of Psychiatry, Oregon Health & Science University, 3710 SW US Veterans Hospital Road, Portland, OR, 97239, USA

    Benjamin J. Morasco PhD & Steven K. Dobscha MD

  2. Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland VA Medical Center, Portland, OR, USA

    Jonathan P. Duckart MPS & Steven K. Dobscha MD

Authors
  1. Benjamin J. Morasco PhD
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  2. Jonathan P. Duckart MPS
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  3. Steven K. Dobscha MD
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Correspondence to Benjamin J. Morasco PhD.

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Morasco, B.J., Duckart, J.P. & Dobscha, S.K. Adherence to Clinical Guidelines for Opioid Therapy for Chronic Pain in Patients with Substance Use Disorder. J GEN INTERN MED 26, 965–971 (2011). https://doi.org/10.1007/s11606-011-1734-5

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  • DOI: https://doi.org/10.1007/s11606-011-1734-5

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