This study examined characteristics associated with prescription drug use disorder (PDUD) in primary care patients with chronic pain from a cross-sectional survey conducted at an urban academically-affiliated safety-net hospital. Participants were 18-60 years old, had pain for ≥ 3 months, took prescription or non-prescription analgesics, and spoke English. Measurements included the Composite International Diagnostic Interview (PDUD, other substance use disorders (SUD), Post-traumatic Stress Disorder (PTSD)); Graded Chronic Pain Scale, smoking status; family history of SUD; and time spent in jail. Of 597 patients (41% male, 61% black, mean age 46 years), 110 (18.4%) had PDUD of whom 99 (90%) had another SUD. In adjusted analyses, those with PDUD were more likely than those without any current or past SUD to report jail time (OR 5.1, 95% CI 2.8-9.3), family history of SUD (OR 3.4, 1.9-6.0), greater pain-related limitations (OR 3.8,1.2-11.7), cigarette smoking (OR 3.6, 2.0-6.2), or to be white (OR 3.2, 1.7-6.0), male (OR 1.9, 1.1-3.5) or have PTSD (OR 1.9, 1.1-3.4). PDUD appears increased among those with easily identifiable characteristics. The challenge is to determine who among those with risk factors can avoid, with proper management, developing the increasingly common diagnosis of PDUD.For reprints and correspondence: Jane Liebschutz MD MPH, Section of General Internal Medicine, Boston Medical Center, 801 Massachusetts Ave, 2 nd Floor, Boston, MA 02118-2334, jane.liebschutz@bmc.org. PERSPECTIVE This article examines risk factors for prescription drug use disorder (PDUD) among a sample of primary care patients with chronic pain at an urban, academic, safety-net hospital. The findings may help clinicians identify those most at risk for developing PDUD when developing appropriate treatment plans.

The Current Opioid Misuse Measure (COMM), a self-report assessment of past-month aberrant medication-related behaviors, has been validated in specialty pain management patients. The performance characteristics of the COMM were evaluated in primary care (PC) patients with chronic pain. It was hypothesized that the COMM can identify patients with prescription drug use disorder (PDD). English-speaking adults awaiting PC visits at an urban, safety-net hospital, who had chronic pain and had received any opioid analgesic prescription in the past year were administered the COMM. The Composite International Diagnostic Interview served as the “gold-standard”, using DSM-IV criteria for PDD and other substance use disorders (SUDs). A receiver operating characteristics (ROC) curve demonstrated the COMM’s diagnostic test characteristics. Of the 238 participants, 27 (11%) met DSM-IV PDD criteria, while 17 (7%) had other SUDs, and 194 (82%) had no disorder. The mean COMM score was higher in those with PDD than among all others (i.e., those with other SUDs or no disorder, mean 20.4 [SD 10.8] vs. 8.4 [SD 7.5], p<0.0001). A COMM score of ≥13 had a sensitivity of 77% and a specificity of 77% for identifying patients with PDD. The area under the ROC curve was 0.84. For chronic pain patients prescribed opioids, the development of PDD is an undesirable complication. Among PC patients with chronic pain prescribed prescription opioids, the COMM is a promising tool for identifying those with PDD.

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