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Pain and Aberrant Drug-Related Behaviors in Medically Ill Patients With and Without Histories of Substance Abuse

Passik, Steven D PhD*; Kirsh, Kenneth L PhD; Donaghy, Kathleen B PhD; Portenoy, Russell K MD§

doi: 10.1097/01.ajp.0000161525.48245.aa
Original Article

Objectives: This study evaluated the prevalence and correlates of aberrant drug-taking behaviors in two populations: patients with HIV-related pain and a history of substance abuse (n = 73) and patients with cancer pain and no history of substance abuse (n = 100).

Methods: All patients completed a Drug-Taking Behaviors Interview, the Brief Symptom Inventory (BSI), Brief Pain Inventory (BPI), Memorial Symptom Assessment Scale (MSAS), and the Marlowe Crowne Social Desirability Scale (MCSDS). The Pain Management Index was calculated to assess the adequacy of opioid prescribing.

Results: The cancer sample comprised 38 men and 62 women, and the AIDS sample comprised 63 men and 10 women. Patients with AIDS-related pain had higher global distress on the MSAS (F1, 170 = 20.05, P < 0.001), greater pain-related interference in their daily functioning on the BPI (F1, 161 = 22.87, P < 0.001), and a lower percentage of relief from their current medications (F1, 156 = 76.14, P < 0.001). AIDS patients also reported more than twice as many examples of aberrant drug-related behaviors per patient (mean = 6.14, SD = 4.60) as the cancer patients (mean = 1.42, SD = 1.91).

Conclusion: These data suggest that AIDS patients with histories of substance abuse receiving opioid therapy are more symptomatic, have more distress, experience more interference from residual pain, and engage in more problematic drug-related behaviors than patients with no history of drug abuse receiving opioids for cancer pain. Treatment of substance abusers with pain requires skills that complement best practices in opioid prescribing. Better approaches to the long-term treatment of these populations are needed.

From *Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY; †Markey Cancer Center, University of Kentucky, Lexington, KY; ‡Donaghy Consulting, Phoenix, AZ; and §Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY.

Received for publication February 14, 2004; revised February 1, 2005; accepted February 14, 2005.

Funded by a grant from the National Institute on Drug Abuse (NIDA grant: 1 R03 DA12061-01).

Reprints: Kenneth L. Kirsh, PhD, Markey Cancer Center, University of Kentucky, 800 Rose Street, CC129, Lexington, KY 40536-0093 (e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.