Journal of Pain and Symptom Management
Volume 40, Issue 2 , Pages 279-289 , August 2010

An Analysis of Heavy Utilizers of Opioids for Chronic Noncancer Pain in the TROUP Study

  • Mark J. Edlund, MD, PhD

      Affiliations

    • Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
    • Corresponding Author InformationAddress correspondence to: Mark J. Edlund, MD, PhD, Division of Health Services Research, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 554, Little Rock, AR 72205, USA.
    • ,
  • Bradley C. Martin, PharmD, PhD

      Affiliations

    • Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
    • ,
  • Ming-Yu Fan, PhD

      Affiliations

    • Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
    • ,
  • Jennifer Brennan Braden, MD, MPH

      Affiliations

    • Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
    • ,
  • Andrea Devries, PhD

      Affiliations

    • HealthCore, Inc., Wilmington, Delaware, USA
    • ,
  • Mark D. Sullivan, MD, PhD

      Affiliations

    • Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA

,Accepted 12 January 2010.

References 

  1. Gureje O, Von Korff M, Simon GE, Gater R. Persistent pain and well-being: a World Health Organization study in primary care. JAMA. 1998;280:147–151
  2. Verhaak PF, Kerssens JJ, Dekker J, Sorbi MJ, Bensing JM. Prevalence of chronic benign pain disorder among adults: a review of the literature. Pain. 1998;77:231–239
  3. Edlund MJ, Steffick D, Hudson T, Harris KM, Sullivan M. Risk factors for clinically recognized opioid abuse and dependence among veterans using opioids for chronic non-cancer pain. Pain. 2007;129:355–362
  4. Hudson TJ, Edlund MJ, Steffick DE, Tripathi SP, Sullivan MD. Epidemiology of regular prescribed opioid use: results from a national, population-based survey. J Pain Symptom Manage. 2008;36:280–288
  5. Elliott AM, Smith BH, Hannaford PC, Smith WC, Chambers WA. The course of chronic pain in the community: results of a 4-year follow-up study. Pain. 2002;99:299–307
  6. Stang P, Von Korff M, Galer BS. Reduced labor force participation among primary care patients with headache. J Gen Intern Med. 1998;13:296–302
  7. Gilson AM, Ryan KM, Joranson DE, Dahl JL. A reassessment of trends in the medical use and abuse of opioid analgesics and implications for diversion control: 1997-2002. J Pain Symptom Manage. 2004;28:176–188
  8. Zacny J, Bigelow G, Compton P, et al. College on Problems of Drug Dependence taskforce on prescription opioid non-medical use and abuse: position statement. Drug Alcohol Depend. 2003;69:215–232
  9. Zerzan JT, Morden NE, Soumerai S, et al. Trends and geographic variation of opiate medication use in state Medicaid fee-for-service programs, 1996 to 2002. Med Care. 2006;44(11):1005–1010
  10. Unutzer J, Ferrell B, Lin EH, et al. Pharmacotherapy of pain in depressed older adults. J Am Geriatr Soc. 2004;52(11):1916–1922
  11. Luo X, Pietrobon R, Hey L. Patterns and trends in opioid use among individuals with back pain in the United States. Spine. 2004;29(8):884–891
  12. Chelminski PR, Ives TJ, Felix KM, et al. A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity. BMC Health Serv Res. 2005;5:3
  13. Schieffer BM, Pham Q, Labus J, et al. Pain medication beliefs and medication misuse in chronic pain. J Pain. 2005;6:620–629
  14. Michna E, Ross EL, Hynes WL, et al. Predicting aberrant drug behavior in patients treated for chronic pain: importance of abuse history. J Pain Symptom Manage. 2004;28:250–258
  15. Cowan DT, Wilson-Barnett J, Griffiths P, Allan LG. A survey of chronic noncancer pain patients prescribed opioid analgesics. Pain Med. 2003;4:340–351
  16. Jonasson U, Jonasson B, Wickstrom L, Andersson E, Saldeen T. Analgesic use disorders among orthopedic and chronic pain patients at a rehabilitation clinic. Subst Use Misuse. 1998;33:1375–1385
  17. Chabal C, Erjavec MK, Jacobson L, Mariano A, Chaney E. Prescription opiate abuse in chronic pain patients: clinical criteria, incidence, and predictors. Clin J Pain. 1997;13:150–155
  18. Department of Health and Human Services . Prescription opioid use and abuse in the treatment of pain. Request for applications (RFA) number: RFA-DA-06–005. Available from http://grants.nih.gov/grants/guide/rfa-files/RFA-DA-06-005.html2005;Accessed June 1, 2010
  19. Compton WM, Volkow ND. Major increases in opioid analgesic abuse in the United States: concerns and strategies. Drug Alcohol Depend. 2006;81:103–107
  20. Food and Drug Administration . Background on Opioid REMS. Available from http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm187975.htmAccessed June 1, 2010
  21. Sullivan MD, Edlund MJ, Fan MY, et al. Trends in use of opioids for non-cancer pain conditions 2000-2005 in commercial and Medicaid insurance plans: the TROUP study. Pain. 2008;138:440–449
  22. Braden JB, Fan MY, Edlund MJ, et al. Trends in use of opioids by noncancer pain type 2000-2005 among Arkansas Medicaid and HealthCore enrollees: results from the TROUP study. J Pain. 2008;9(11):1026–1035
  23. Edlund MJ, Martin BC, DeVries A, et al. Trends in use of opioids for chronic non-cancer pain in individuals with mental health and substance use disorders: the TROUP study. Clinical J Pain. 2010;26:1–8
  24. Arkansas Department of Health Human Services, Division of Medical Services . Program overview—state fiscal year. Available from https://www.medicaid.state.ar.us2005;Accessed June 9, 2010
  25. Cicero TJ, Surratt H, Inciardi JA, Mnunoz A. Relationship between therapeutic use and abuse of opioid analgesics in rural, suburban, and urban locations in the United States. Pharmacoepidemiol Drug Saf. 2007;16:827–840
  26. Hennessy S, Bilker WB, Weber A, Strom BL. Descriptive analyses of the integrity of a US Medicaid claims database. Pharmacoepidemiol Drug Safety. 2003;12:103–111
  27. American Pain Society . Principles of analgesic use in the treatment of acute pain and cancer pain. 5th ed. Glenview, IL: American Pain Society; 2003;
  28. Vieweg WV, Lipps WF, Fernandez A. Opioids and methadone equivalents for clinicians. Prim Care Companion J Clin Psychiatry. 2005;7:86–88
  29. Fine P, Portenoy RK. A clinical guide to opioid analgesia. Minneapolis, MN: McGraw-Hill Healthcare Information; 2004;
  30. Agency for Health Care Research and Quality . Clinical classifications software (CCS) for ICD-9-CM. Available from http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jspAccessed June 3, 2009
  31. Washington State Agency Medical Directors' Group. Interagency guideline on opioid dosing for chronic non-cancer pain: an educational pilot to improve care and safety with opioid treatment. 2007.
  32. U.S. Drug Enforcement Administration . Drug scheduling. Available from http://www.usdoj.gov/dea/pubs/scheduling.htmlAccessed February 24, 2009
  33. Katz JN, Barrett J, Liang MH, et al. Sensitivity and positive predictive value of Medicare Part B physician claims for rheumatologic diagnoses and procedures. Arthritis Rheum. 1997;40:1594–1600
  34. Cicero TJ, Shores CN, Paradis AG, Ellis MS. Source of drugs for prescription opioid analgesic abusers: a role for the internet?. Pain Med. 2008;9:718–723

 This work was supported by NIDA R01 DA022560-01.

PII: S0885-3924(10)00323-4

doi: 10.1016/j.jpainsymman.2010.01.012

Journal of Pain and Symptom Management
Volume 40, Issue 2 , Pages 279-289 , August 2010

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