• Laxmaiah Manchikanti, Kim S Damron, Vidyasagar Pampati, and Carla D McManus.
• Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, Kentucky 42003, USA. drm@apex.net
• Pain Physician. 2004 Jul 1; 7 (3): 339-44.

BackgroundMultiple aberrant behaviors have been described to identify patients abusing opioids and using illicit drugs. However, patient behavior encompassing aggressive seeking or complaining about the need for higher doses of opioids has not yet been evaluated with regards to misuse or abuse patterns of prescription drugs and illicit drug usage.ObjectiveThe objective of this study was to evaluate and identify the prevalence of illicit drug use and prescription drug abuse or misuse in patients seeking higher doses of opioids and compare to a group of patients not seeking higher doses of opioids.DesignA prospective, non-randomized, consecutive, observational study.MethodsA total of 200 patients from an interventional pain management setting with 100 consecutive patients in each group either not seeking additional opioids (Group I) or seeking higher doses of opioids (Group II) were evaluated with urine testing for illicit drug use, and/or misuse or abuse of opioids. Drug testing was carried out by Rapid Drug Screen.ResultsResults of this study showed a significantly greater proportion of patients in Group II using illicit drugs (15% vs 32% P = 0.005). Combined use of illicit drugs and abuse of non-prescribed opioids was also present in a significantly greater proportion of patients in Group II (15% vs 39% P = 0.000). A significant number of patients in Group I (32%) and Group II (30%) failed to show the prescribed drug in their urine.ConclusionA significant proportion of patients, whether they were seeking additional opioids or not, used illicit drugs. Further, a greater proportion of patients in Group II used illicit drugs and non-prescribed opioids.

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