History of drug use predicts opioid treatment agreement violation.

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.

The EVMS pain education initiative: a multifaceted approach to resident education.

UNLABELLED: Chronic pain is a major health issue that causes significant patient morbidity as well as economic loss. Many studies have highlighted the lack of training in chronic pain management for resident physicians and the need to develop programs that address the challenges of providing care to chronic pain patients. We wanted to determine whether a workshop using a combination of standardized patients, small groups, and large group lectures addresses residents' curricular needs regarding chronic pain management. We developed a 1-day workshop for residents at Eastern Virginia Medical School, which has a nationally recognized professional skills center. After completing the workshop, residents showed significant gains in knowledge (post-test vs pre-test overall mean +23.4%, P < .001). Significant gains in clinical skills were also seen (overall +5.9%, P < .001) with improvements in the areas of pain assessment (+6.3%, P < .001), physical examination (+7.7%, P < .03), and pain management (+8%, P < .01). Physicians also reported increased comfort regarding chronic pain management. Almost all residents stated they would make specific practice changes in the assessment and management of chronic pain patients. The results suggest our workshop is a novel model that is effective in teaching residents how to assess and manage chronic pain. PERSPECTIVE: This article demonstrates that the use of standardized patients with other teaching methods is an effective approach in teaching resident physicians regarding the assessment and management of chronic pain patients. The findings have the potential to restructure our methods of teaching in chronic pain education.