Purpose: Problem drug-related behavior (PDB) among patients on chronic opioid therapy may reflect an opioid use disorder. This study assessed PDB prevalence and the relationship between PDB and ongoing prescription of opioids at a primary care clinic that implemented a multifaceted opioid management program.Methods: A chart review of patients in a chronic opioid registry assessed prevalence of different types of PDB over 2 years, and whether opioids were prescribed during the last 3 months of the 2-year study period among patients with different levels of PDB.Results: Among 233 registry patients, 84.1% exhibited PDB; 45.5% exhibited >3 types of PDB. At the end of 2 years, most registry patients were still prescribed opioids, though patients with >3 types of PDB were less likely than those without PDB to be prescribed opioids (62.3% vs. 78.4%, P ‫؍‬ 0.016).Conclusions: PDB was pervasive in this population of patients on chronic opioid therapy. Those with the most PDB, and thus with the greatest likelihood of opioid use disorder and its social and medical consequences, were the least likely to be prescribed opioids by the clinic after 2 years. Given the rising rates of illicit opioid use in the U.S., it is important that clinics work closely with their patients who display PDB, systematically assess them for opioid use disorder, and offer evidence-based treatment.

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demonstrated longer time to stone resolution (52 vs 33 days, p[0.049), larger stone size (9 vs 5 mm, p[0.015), opiate prescribed at presentation (86 vs 53%, p[0.003), and surgery needed to clear the stone (86 vs 44%, p<0.001) were associated with increased risk of requiring an opiate prescription refill. On multivariable analysis controlling for age, sex, stone size, and time to stone passage or surgery, an opiate prescription at presentation (95% CI 0.090-0.433, p[0.003) and surgery to clear the stone (0.044-0.440, p[0.017) were independent predictors of opiate refills prior to stone resolution.CONCLUSIONS: Patients prescribed opiates in the ED for acute nephrolithiasis are likely to require refills before resolution of the stone episode. Larger stones that require surgery (not spontaneous passage) also increase the risk. Timely treatment of these patients and initial treatment with non-narcotics may reduce the risk of prolonged opiate use.