Background: Reports of chronic pain and associated opioid use, abuse, and fatalities continue
to increase at an alarming rate, not only in the United States but also across the globe. In light
of the many resultant fatalities, multiple authors and authorities have cautioned against the
excessive use of opioids. Consequently, the Food and Drug Administration, Drug Enforcement
Administration, and multiple state authorities have been proposing and implementing a plethora
of regulations to curb opioid overuse and abuse. In the majority of cases, pain physicians have
been portrayed as the perpetrators responsible for escalating use and abuse and resultant
fatalities.
Objectives: To assess the patterns of psychotherapeutic drug use and illicit drug use at the
time of initial evaluation.
Study Design: A prospective evaluation.
Setting: A private, specialty referral interventional pain management clinic in the United States.
Methods: Participants were all new patients presenting to interventional pain management
evaluated by one physician. Inclusion criteria was patients over 18 years of age with chronic
spinal pain of at least one year duration.
Results: The results of this evaluation indicate that 94% of patients were on long-term opioids
prior to presenting to interventional pain management. Illicit drug use is also common, although
it has declined significantly. While a large proportion of individuals (45.7%) have used illicit
drugs at some point in the past, current illicit drug use is present in only 7.9% of patients, both
past and current use are similar to that of the general population. More importantly, a significant
proportion of patients have been on opioids (high doses of more than 40 mg equivalents of
morphine 48.8%) on a long-term basis, initiated and maintained by primary care physicians,
prior to presenting to interventional pain management. Further, 35% were on benzodiazepines,
and 9.2% on carisoprodol prior to presenting to interventional pain management.
Limitations: The limitations of this evaluation include that it is a prospective, single center
evaluation by one physician that is partially dependent on subjective recall of the patient.
Conclusion: This study shows an overwhelming majority of patients were initiated and
maintained with opioids in managing chronic noncancer pain. They were frequently on high
doses over a long period of time with multiple drug combinations prescribed by primary care
physicians.
Key Words: Chronic pain, persistent pain, noncancer pain, controlled substances, substance
abuse, prescription drug abuse, opioids, prescriptions, urine drug testing, fatalities, regulations
A Comparative Evaluation of Illicit Drug use in Patients with
or Without Controlled Substance Abuse in Interventional Pain
Management