The Association Between Chronic Pain and Prescription Drug Abuse in Veterans

Authors

  • William C. Becker MD,

    1. Philadelphia Veterans Affairs Medical Center, VISN4 Mental Illness Research, Education, and Clinical Center (MIRECC),
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  • David A. Fiellin MD,

    1. Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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  • Rollin M. Gallagher MD, MPH,

    1. Philadelphia Veterans Affairs Medical Center, VISN4 Mental Illness Research, Education, and Clinical Center (MIRECC),
    2. University of Pennsylvania School of Medicine,
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  • Kelly S. Barth DO,

    1. Center for the Study of Addictions, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania;
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  • Jennifer T. Ross MS,

    1. Philadelphia Veterans Affairs Medical Center, VISN4 Mental Illness Research, Education, and Clinical Center (MIRECC),
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  • David W. Oslin MD

    1. Philadelphia Veterans Affairs Medical Center, VISN4 Mental Illness Research, Education, and Clinical Center (MIRECC),
    2. University of Pennsylvania School of Medicine,
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  • Presented at the Society of General Internal Medicine's 2008 National Meeting, Pittsburgh, PA, USA.

  • Original Research Article

William C. Becker, MD, Philadelphia VAMC, 3900 Woodland Avenue, Philadelphia, PA 19104, USA. Tel: 1-215-823-5800 ext. 4575; Fax: 1-215-823-4411; E-mail: William.Becker4@va.gov.

ABSTRACT

Objective.  We sought to investigate the association between chronic pain and self-reported prescription drug abuse in a large cohort of patients referred from primary care for a behavioral health assessment.

Design.  We performed a cross-sectional analysis of responses to a telephone assessment administered to patients referred for a behavioral health evaluation between April 25, 2005 and October 31, 2007. We conducted descriptive statistics and investigated multivariable associations. Multivariable analyses included age, gender, race, financial status, employment, current smoking, drinking problem, past-year illicit drug use, depression, and chronic pain.

Patients.  Veterans referred from primary care (N = 6,377).

Results.  Mean age of the sample was 56.5 years with a range of 19–97. The majority of respondents was white, unmarried, and was unemployed. Nearly 5% of the sample reported past 6-month prescription drug abuse. On multivariable analysis, younger age, possible depression (odds ratio [OR] 1.9; 1.3–2.8), probable depression (OR 2.4; 1.6–3.4), smoking (OR 1.4; 1.1–1.8), illicit drug use (OR 2.8; 2.2–3.7), and chronic pain (OR 1.9; 1.4–2.5) were associated with prescription drug abuse.

Conclusions.  We have identified specific variables associated with self-reported prescription drug abuse in primary care patients. Chronic pain is associated both with an indication for prescribing opioids and with abuse of prescription medications. Clinicians are encouraged to follow treatment algorithms when managing patients with chronic pain as a method for reducing misuse.

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