Chronic opioid therapy for nonmalignant pain in patients with a history of substance abuse: report of 20 cases.

A history of substance abuse is considered by many to be a contraindication to chronic opioid therapy for nonmalignant pain. Twenty patients with a history of chronic nonmalignant pain and substance abuse treated with chronic opioid therapy for a period of more than 1 year were retrospectively evaluated to determine the factors associated with prescription abuse. The prevalence of six aberrant behavioral patterns was assessed to see if these correlated with a history of prescription abuse, as reported by the patient's pain clinic physician. Those who did not abuse opioid therapy were more likely to have a history of alcohol abuse alone or a remote history of polysubstance abuse. They were also more likely to be active members of Alcoholics Anonymous and to have a stable family or other similar support system. In contrast, those who abused opioid therapy showed characteristic aberrant patterns of behavior in their management, which indicated a clear pattern of prescription abuse early in the course of therapy. Those patients were more likely to be recent polysubstance abusers, or have a prior history of oxycodone abuse. None of them were active members of Alcoholics Anonymous. Signing an "opioids contract" was not in and of itself a predictor of successful outcome.