1. 2003;6;281-285A Comparative Evaluation of Illicit Drug use in Patients with or Without Controlled Substance Abuse in Interventional Pain Management
   An Original Contribution
   Laxmaiah Manchikanti, MD, Kim S. Damron, RN, Carla D. Beyer, RN, BSN, and Vidyasagar Pampati, MSc.

The prevalence of illicit drug use by patients in a chronic pain management practice who concomitantly abuse prescription -controlled substances is not known. The purpose of this study was to determine the prevalence of illicit drug use by patients in an interventional pain management practice, based on whether or not there was evidence of simultaneous abuse of prescription drugs.

One hundred and fifty patients in an interventional pain management practice who were prescribed controlled substances for pain treatment were selected for assessment of concomitant illicit drug use by urine drug testing. Patients were divided into two groups: Group I consisted of 100 consecutive patients without evidence of controlled substance abuse and Group II consisted of 50 consecutive patients with documented abuse of prescription controlled substances. All patients underwent urine testing with the Rapid Drug Screen™ test. The test is a one-step, lateral flow immunoassay for the simultaneous detection of four illicit drugs (i.e., amphetamine, methamphetamine, marijuana, and cocaine).

Results showed a prevalence of illicit drug abuse in patients without a history of controlled substance abuse of 14%. In contrast, illicit drug abuse in patients with a history of controlled substance abuse was 34%. Marijuana was the drug of choice in both groups, with 22% in the prescription abuse group and 10% in the non-abuse group. The second most commonly used illicit drug in both groups was cocaine.

This study demonstrated a clinically significant use of illicit drugs, particularly marijuana and cocaine in an interventional pain management setting, in patients with or without evidence of concomitant abuse of prescription controlled substances.

Keywords: Drug abuse, illicit drugs, licit drugs, prescription controlled substances, controlled substance agreement, opioid abuse, marijuana, cocaine, methamphetamine, Rapid Drug Screen