Problem Drug-related Behavior and Discontinuation of Opioids Following the Introduction of an Opioid Management Program

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Figure 1.
Sample selection from a registry of patients prescribed chronic opioid therapy between December 1, 2009, and November 30, 2011. ICD-9, International Classification of Diseases, 9th Revision; PDB, problem drug-related behavior.
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Figure 2.
Rates of different types of problem drug-related behavior (PDB) between December 1, 2009, and November 30, 2011, among registry patients. *Prevalence of inconsistent urine drug test (UDT) is calculated as the fraction of patients who had at least 1 UDT. ED, emergency department.

Table 1.

Demographics and Clinical Characteristics by Presence of Problem Drug-Related Behavior

	No PDB	Any PDB	≥3 PDB	Total	P Value
	No PDB	Any PDB	≥3 PDB	Total	Any PDB vs No PDB	≥3 PDB vs No PDB
Patients	37 (15.9)	196 (84.1)	106 (45.5)	233 (100.0)
Age as of December 1, 2009 (years), mean (SD)	56.4 (15.7)	47.1 (12.3)	45.1 (11.6)	48.6 (13.3)	<.001	<.001
Female sex	24 (64.9)	147 (75.0)	81 (76.4)	171 (73.4)	.201	—
White	36 (97.3)	183 (93.4)	101 (95.3)	219 (94.0)	.698^*	—
Not employed (or unknown)	24 (64.9)	140 (71.4)	79 (74.5)	164 (70.4)	.533	—
Public insurance (Medicare/Medicaid)	18 (48.6)	115 (58.7)	62 (58.5)	133 (57.1)	.258	—
Duration of opioid prescription (months) as of December 1, 2009, mean (SD)	38.4 (15.4)	37.7 (15.6)	38.0 (16.4)	37.8 (15.5)	.793	—
Smoker	11 (29.7)	100 (51.0)	62 (58.5)	111 (47.6)	.017	.003
Depression	18 (48.6)	143 (73.0)	84 (79.2)	161 (69.1)	.003	<.001
Anxiety	9 (24.3)	105 (53.6)	64 (60.4)	114 (48.9)	.001	<.001
PTSD	2 (5.4)	24 (12.2)	16 (15.1)	26 (11.2)	.390^*	—

Data are n (%) unless otherwise indicated. Statistically significant P values are shown in boldface.
↵* Calculated using the Fisher exact test.
PDB, problem drug-related behavior; PTSD, post-traumatic stress disorder; SD, standard deviation.

Table 2.

Opioid-Related Clinical Care by Presence of Problem Drug-Related Behavior

	No PDB	Any PDB	≥3 PDB	Total	P Value
	No PDB	Any PDB	≥3 PDB	Total	Any PDB vs No PDB	≥3 PDB vs No PDB
Patients	37 (15.9)	196 (84.1)	106 (45.5)	233 (100.0)
Disposition					.051	.016
Clinic still prescribing opioids	29 (78.4)	135 (68.9)	66 (62.3)	164 (70.4)
Clinic no longer prescribing opioids^*	8 (21.6)	61 (31.1)	40 (37.7)	69 (29.6)
MED, mean (SD)	41.7 (55.4)	133.8 (273.2)	169.0 (319.7)	119.2 (253.7)	<.001	<.001
Treatment agreement	27 (73.0)	173 (88.3)	95 (89.6)	200 (85.8)	.014	.014
Had UDT	18 (48.6)	150 (76.5)	93 (87.7)	168 (72.1)	<.001	<.001
Visits in 2010, mean (SD)	4.2 (3.0)	8.1 (6.2)	9.2 (6.6)	7.5 (6.0)	<.001	<.001

Data are n (%) unless otherwise indicated. Statistically significant P values are shown in boldface.
↵* Includes 2 patients who entered chemical dependency treatment and 3 who died.
MED, morphine-equivalent dose; PDB, problem drug-related behavior; SD, standard deviation; UDT, urine drug testing.