Balancing risks and benefits of opioids for chronic non-cancer pain (CNCP) challenges primary care providers (PCPs) who must rely on consensus-based guidelines that are not evidence-based. The ORC, a pharmacist-run program supporting PCPs caring for patients taking opioids for CNCP who demonstrated aberrant behavior or substance misuse/abuse risk, successfully managed opioids for 72.5 % of referrals over two years (Wiedemer 2007). This study compares the characteristics of those PCP patients taking opioids for CNCP who were referred to ORC (ORCPs) to those who were taking opioids for CNCP and not referred (PCPPs).

Methods:

Electronic medical record extraction data compared ORC patients (ORCPs) (n=401) with a randomly selected sample of non-referred PCP patients (PCPPs), also prescribed opioids (n=418), on demographics, pain diagnoses, and medical, psychiatric and addiction comorbidities using descriptive and bivariate analyses.

Results:

Mean age = 57, 7% females. ORCPs were younger (p<.001), more likely unemployed (p<.01), more often black (p< .05) and less likely married (p<.001). 79% of the entire sample had a low back pain diagnosis, with a higher prevalence in OCRPs (p<.001). ORCP also demonstrated a higher prevalence of osteoarthritis (p<.01), radicular neuropathy (p<.01), depression (p<.05), and addiction disorder [alcohol and cocaine (p< .01), opioids (p<.001)], whereas PTSD was borderline (p =.06). The prevalence of hypertension and diabetes was 78.4% and 40.9% respectively without significant between-group differences, whereas hepatitis C was more prevalent in ORCP (p<.001).

Conclusions:

This study provides evidence that PCPs manage patients with a high burden of medical co-morbidities and pain related diagnoses. When given the opportunity, PCPs tend to refer at risk patients with higher medical, psychiatric and addiction co-morbidities for assistance with continuing opioid management for CNCP.