Journal of addiction medicine
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To estimate the prevalence of self-reported substance use and psychiatric disorders in a highly select chronic nonmalignant pain population within a nonprimary care tertiary referral-only pain clinic. ⋯ Certain populations of patients with complex nocioceptive, neuropathic, and myofascial pain syndromes may have a lower prevalence of substance use disorders than the general population. They also may have concurrent psychiatric disorders, which should be evaluated and treated concomitantly as part of their chronic pain treatment. Rates reported for possible obsessive-compulsive personality disorder may be reflective of patients' expected preoccupation with pain complaints. The low prevalence of substance use disorders may be attributable to the severity of their illness, the patients' inability to achieve pain relief and obtain pain medications easily, as well as their persistence in pursuing accurate diagnoses and treatment. Roughly one-third were not currently prescribed opioids at the time of the study, perhaps undercutting risk for opioid use disorder rates. Additionally, due to the tertiary referral nature of this clinic, patients with behaviors believed to be a manifestation of opioid use disorder may have already been selected out prior to referral to this clinic. A major limitation of this study was that it relied on a self-report assessment instrument and there were no drug screen findings to report. Such unique clinic characteristics and study limitations may narrow generalizability of results. Despite the low prevalence of substance use disorders observed for this clinic population, these patients must be continuously monitored for abuse, misuse, and diversion of their medication.
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Recent work offers evidence that nonmedical use of prescription medications (NUPM) may precipitate the development and recurrence of psychopathology. This work further explores this relationship by examining the dose-related effects of past year opioid and pooled tranquilizer/sedative NUPM on incidence and recurrence of psychopathology. ⋯ Any opioid or tranquilizer/sedative NUPM may increase risk for alcohol use disorder and non-NUPM substance use disorder, with weekly/daily opioid or tranquilizer/sedative nonmedical users appearing to be most vulnerable to the incidence and recurrence of depressive, bipolar, and anxiety disorders. This work highlights the importance of screening for the NUPM by clinicians, and it highlights the need for further research to better understand the psychopathology-NUPM interaction.