• Deborah L Haller and Michelle C Acosta.
• St. Luke's-Roosevelt Hospital Center Behavioral Science Research Unit, 11th Fl., 1111 Amsterdam Ave., New York, NY 10025, USA. dhaller@chpnet.org
• Psychosomatics. 2010 May 1; 51 (3): 257-66.

Background"Nonmedical" (i.e., illicit) use of opioid analgesics has skyrocketed among the general population during the past decade, with similar increases observed among pain patients who take opioids by prescription.ObjectiveBecause 1 in 3 opioid-maintained pain patients may be affected, it is essential that healthcare providers learn more about this subpopulation as a first step toward improved detection, brief intervention, referral, and general management.MethodThe authors examined baseline data for 40 chronic-pain patients in a treatment trial targeting opioid analgesic abuse.ResultsAbuse-disorder patients were dysfunctional and had high rates of psychiatric disorders and troublesome personality traits. Providers characterized patients as manipulative, drug-seeking, and noncompliant; patients complained that they were pharmacologically undertreated and were considered "addicts." Despite having severe pain and addiction, their average daily opioid dose was only 69% of that used to treat addiction in the same geographic region.ConclusionAbuse-disorder patients had a similar physical but worse psychiatric/personality presentation than other chronic-pain patients, which suggests the need for increased psychiatric involvement.

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