Demographic characteristics and clinical predictors of patients discharged from university hospital-affiliated pain clinic due to breach in narcotic use contract

Shushovan Chakrabortty, MD, PhD; Deepak Gupta, MD; David Rustom, MD; Hussein Berry; Ajit Rai

doi:10.5055/jom.2014.0237

Authors

Shushovan Chakrabortty, MD, PhD
Deepak Gupta, MD
David Rustom, MD
Hussein Berry
Ajit Rai

DOI:

https://doi.org/10.5055/jom.2014.0237

Keywords:

narcotic use contract, discharges from pain clinics, doctor shopping, substance abuse, medication diversion

Abstract

Objective: The current retrospective study was completed with the aim to identify

demographic characteristics and clinical predictors (if any) of the patients discharged

from our pain clinic due to breach in narcotic use contract (BNUC).

Design: Retrospective patient charts' review and data audit.

Setting: University hospital-affiliated pain clinic in the United States.

Participants: All patient charts in our pain clinic for a 2-year period (2011-2012).

Interventions: The patients with BNUC were delineated from the patients who had not been discharged from our pain clinic.

Main outcome measures: Pain characteristics, pain management, and substance abuse status were compared in each patient with BNUC between the time of admission and the time of discharge.

Results: The patients with BNUC discharges showed significant variability for the discharging factors among the pain physicians within a single pain clinic model with this variability being dependent on their years of experience and their proactive interventional pain management. The patients with BNUC in our pain clinic setting were primarily middle-aged, obese, unmarried males with nondocumented stable occupational history who were receiving only noninterventional pain management. Substance abuse, doctor shopping, and potential diversion were the top three documented reasons for BNUC discharges.

Conclusion: In 2011-2012, our pain clinic discharged 1-in-16 patients due to breach in narcotic use contract.

Author Biographies

Shushovan Chakrabortty, MD, PhD

Clinical Assistant Professor, Department of Anesthesiology and Pain Medicine, Detroit Medical Center, Wayne State University, Detroit, Michigan.

Deepak Gupta, MD

Clinical Assistant Professor, Department of Anesthesiology and Pain Medicine, Detroit Medical Center, Wayne State University, Detroit, Michigan.

David Rustom, MD

Resident, Department of Physical Medicine and Rehabilitation, Detroit Medical Center, Wayne State University, Detroit, Michigan.

Hussein Berry

Graduate Student, Department of Anesthesiology and Pain Medicine, Detroit Medical Center, Wayne State University, Detroit, Michigan.

Ajit Rai

Medical Student, Department of Anesthesiology and Pain Medicine, Detroit Medical Center, Wayne State University, Detroit, Michigan.

References

Weiner H, Schut J: The interaction between counseling and methadone in the treatment of narcotic addicts: The challenge of the counseling relationship. Int J Clin Pharmacol Biopharm. 1975; 11(4): 292-298.

Touchet BK, Yates WR, Coon KA: Opioid contract use is associated with physician training level and practice specialty. J Opioid Manag. 2005; 1(4): 195-200. DOI: https://doi.org/10.5055/jom.2005.0042

Hariharan J, Lamb GC, Neuner JM: Long-term opioid contract use for chronic pain management in primary care practice. A five year experience. J Gen Intern Med. 2007; 22(4): 485-490. DOI: https://doi.org/10.1007/s11606-006-0084-1

Buchman DZ, Ho A: What's trust got to do with it? Revisiting opioid contracts. J Med Ethics. 2014; 40: 673-677. DOI: https://doi.org/10.1136/medethics-2013-101320

Deep K: Use of narcotics contracts. Virtual Mentor. 2013; 15(5): 416-420. DOI: https://doi.org/10.1001/virtualmentor.2013.15.5.ecas3-1305

Penko J, Mattson J, Miaskowski C, et al.: Do patients know they are on pain medication agreements?. Results from a sample of high-risk patients on chronic opioid therapy. Pain Med. 2012; 13(9): 1174-1180. DOI: https://doi.org/10.1111/j.1526-4637.2012.01430.x

Becker WC, Meghani SH, Barth KS, et al.: Characteristics and outcomes of patients discharged from the Opioid Renewal Clinic at the Philadelphia VA Medical Center. Am J Addict. 2009; 18(2): 135-139. DOI: https://doi.org/10.1080/10550490902772496

Compton P: Should opioid abusers be discharged from opioid-analgesic therapy? Pain Med. 2008; 9(4): 383-390. DOI: https://doi.org/10.1111/j.1526-4637.2008.00462.x

Meghani SH, Wiedemer NL, Becker WC, et al.: Predictors of resolution of aberrant drug behavior in chronic pain patients treated in a structured opioid risk management program. Pain Med. 2009; 10(5): 858-865. DOI: https://doi.org/10.1111/j.1526-4637.2009.00643.x

Fishbain DA, Cole B, Lewis J, et al.: What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors?. A structured evidence-based review. Pain Med. 2008; 9(4): 444-459. DOI: https://doi.org/10.1111/j.1526-4637.2007.00370.x

Melanson SE, Tanasijevic MJ, Snyder ML, et al.: Significant cost savings achieved by in-sourcing urine drug testing for monitoring medication compliance in pain management. Clin Chim Acta. 2013; 422: 10-14. DOI: https://doi.org/10.1016/j.cca.2013.03.010

Dimeski G, Silvester B, Ungerer J, et al.: Policy change to improve pathology turnaround time and reduce costs—Possible to do both? Biochem Med (Zagreb). 2013; 23(3): 296-302. DOI: https://doi.org/10.11613/BM.2013.035

Starrels JL, Becker WC, Alford DP, et al.: Systematic review: Treatment agreements and urine drug testing to reduce opioid misuse in patients with chronic pain. Ann Intern Med. 2010; 152(11): 712-720. DOI: https://doi.org/10.7326/0003-4819-152-11-201006010-00004