Predictors of Resolution of Aberrant Drug Behavior in Chronic Pain Patients Treated in a Structured Opioid Risk Management Program
Predictors of Resolution of Aberrant Drug Behavior in Chronic Pain Patients Treated in a Structured Opioid Risk Management Program
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DOI：
10.1111/j.1526-4637.2009.00643.x
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发表时间：
2009-07-01
期刊：
影响因子：
3.1
通讯作者：
Gallagher, Rollin M.
中科院分区：
文献类型：
--
作者：
Meghani, Salimah H.;Wiedemer, Nancy L.;Gallagher, Rollin M.
目的：确定一组由初级保健提供者（PCP）转诊至阿片类药物更新诊所（ORC）的患者中异常药物相关行为（ADRB）解决的人口统计学和临床预测因素。ORC是一个支持PCPs使用阿片类药物治疗慢性疼痛的项目，患者被认为有阿片类药物滥用的风险或有ADRBs.Methods的患者，对2002年1月17日至2004年8月27日期间195名连续受试者进行回顾性病历审查，以了解ADRBs。二元逻辑回归，以确定独立的预测因素异常行为的结果在1 year.Results.Of 195参考，45.6%（N = 89）解决他们的ADRB在1年。其他结局，分类为ADRB未消退、自行出院或因无法遵守阿片类药物治疗协议而被ORC出院（N = 86，44.1%）和接受成瘾治疗转诊（N = 20，10.2%）。可卡因滥用史使该计划失败的几率增加了5倍（比值比[OR] = 4.97，P = 0.001）。每增加一个疼痛诊断，失败的几率降低16%（OR = 0.837，P = 0.008）。与单身者相比，已婚者ORC计划失败的可能性降低62%（OR = 0.38，P = 0.028）。滥用可卡因的患者失败的风险更高，这表明需要进一步研究安全有效的方法来管理这个复杂的患者子集的疼痛。异常行为倾向于在多个疼痛部位的患者中解决，可能是因为他们渴望缓解。
Objective.To identify demographic and clinical predictors of the resolution of aberrant drug-related behaviors (ADRBs) in a group of patients referred to the Opioid Renewal Clinic (ORC) by their primary care providers (PCPs). ORC is a program supporting PCPs' use of opioids for chronic pain in patients perceived as at risk for opioid abuse or those with demonstrated ADRBs.Methods.A retrospective chart review was conducted for 195 consecutive subjects referred to the ORC from January 17, 2002 to August 27, 2004, for ADRBs. Binary logistic regression was employed to identify independent predictors of aberrant behavior outcome at 1 year.Results.Of the 195 referred, 45.6% (N = 89) resolved their ADRB at 1 year. Other outcomes, classified as nonresolution of ADRB, self-discharged or discharged by the ORC for inability to adhere to the opioid treatment agreement (N = 86, 44.1%) and acceptance of referral for addiction treatment (N = 20, 10.2%). A history of cocaine abuse increased the odds of failing the program by five times (odds ratio [OR] = 4.97, P = 0.001). Each additional pain diagnosis reduced the odds of failure by 16% (OR = 0.837, P = 0.008). When compared with singles, married individuals were 62% less likely to fail the ORC program (OR = 0.38, P = 0.028).Conclusions.Nearly half of the patients resolved their aberrant behavior within the ORC. Patients with cocaine abuse were at higher risk for failure, suggesting a need for further research into safe and effective ways to manage pain in this complex subset of patients. Aberrant behaviors tended to resolve in patients with multiple pain locations, possibly because of their desire for relief.