Study Design: A retrospective, case-controlled study.

Objective: To identify variables in patients with or without illicit drug use.

Background Information: Studies documenting a high incidence of controlled substance abuse in chronic pain continue to increase. Over the years, multiple evaluation tools have been proposed. The need to identify predictors of aberrant drug related behavior and addiction in patients being treated with controlled substances for pain has been emphasized.

Methods: A total of 150 patients were included in the study. One hundred consecutive urine tests without the presence of illicit drugs and 50 consecutive urine tests with the presence of illicit drugs of patients receiving controlled substances, were selected for evaluation of multiple variables of illicit drug use. They were divided into four groups with Group I with no controlled substance abuse and no illicit drug abuse with 70 patients; Group II with no controlled substance abuse, however, with positive illicit drug use with 33 patients; Group III with positive controlled abuse, however, with no illicit drug use with 30 patients; and Group IV with controlled substance abuse and illicit drug use with 17 patients.

Results: Results of this study showed that of the eight variables described in a previous study in identifying controlled substance abuse, four variables were crucial. The four significant items identified in this evaluation were excessive opiate needs, deception or lying to obtain controlled substances, current or prior intentional doctor shopping, and current or prior use of illicit drugs and denial. These four variables were accurate in identifying controlled substance abuse. However, they failed to identify illicit drug use.

Conclusion: The presently available and validated screening tool for controlled substance abuse failed to identify illicit drug use in patients receiving controlled substances.

Keywords: Controlled substance abuse, illicit drug use, drug dependence, substance abuse assessment.