History of drug use predicts opioid treatment agreement violation


  • Pamela Summers, MD, MPH
  • Brook Alemu, MA, MPH, CPH
  • Antonio Quidgley-Nevares, MD




drug use, opioids, opioid treatment agreement


Objective: To determine reasons and describe characteristics of patients who violate their opioid treatment agreement.

Design: Cross-sectional retrospective study.

Participants: New patients aged 18 years or above attending a multidisciplinary comprehensive pain management clinic from January 2012 to June 2012.

Main outcome measure: Reason for discharge from the clinic.

Results: Of the 234 subjects in the study, 38.5 percent were discharged due to treatment agreement violation. A majority had a self-reported history of tobacco use, followed by alcohol and marijuana. The mean age of discharge was 45.1 years (SD 11.6) and they were discharged on average in 7.4 months after their first clinic visit. The primary reason for discharge was for an inappropriate urine drug screen (UDS) with illicit drug use being the most common at 40 percent and marijuana being the most common illicit drug. Subjects reporting a history of any drug use were nearly seven times more likely to be discharged. Hydrocodone was the most common nonprescribed opioid found in the UDS for those discharged for using nonprescribed opioids.

Conclusion: Inappropriate UDS is a main factor for discharge due to violation of the opioid treatment agreement. Those with self-reported current or prior drug use were more likely to be discharged from the clinic.

Author Biographies

Pamela Summers, MD, MPH

PM&R Resident, Eastern Virginia Medical School, Norfolk, Virginia

Brook Alemu, MA, MPH, CPH

Faculty Advisor, Eastern Virginia Medical School, Norfolk, Virginia

Antonio Quidgley-Nevares, MD

Chair, PM&R, Eastern Virginia Medical School, Norfolk, Virginia


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How to Cite

Summers, MD, MPH, P., B. Alemu, MA, MPH, CPH, and A. Quidgley-Nevares, MD. “History of Drug Use Predicts Opioid Treatment Agreement Violation”. Journal of Opioid Management, vol. 11, no. 6, Nov. 2015, pp. 501-6, doi:10.5055/jom.2015.0303.

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