Drug abuse with
illicit drugs and licit drugs has been increasing steadily over the past decade. A recent National Household Survey on
Drug Abuse found statistically significant increases between 2000 and 2001 in the use of multiple drugs, including marijuana,
cocaine, and non-medical use of
pain relievers and tranquilizers. Prescription
controlled substance abuse is a major issue in
chronic pain management. Various means suggested to avoid or monitor abuse in patients in treatment include urine/serum
drug screening whenever requested, along with other precautions including one prescribing physician and one designated pharmacy, etc. Based on the present evidence, physicians assume that patients adhering to
controlled substance agreements and without obvious dependency behavior do not abuse either illicit or licit drugs. Thus, it is accepted that there is no necessity to perform routine urine/
drug testing in this specific group of the patient population. One hundred patients undergoing interventional
pain management and receiving
controlled substances were randomly selected for evaluation of
illicit drug abuse by urine
drug testing. They were selected from a total of 250 patients who were identified as non-abusers of
prescription drugs. Results showed that
illicit drug abuse in patients without history of
controlled substance abuse was seen in 16 patients. Thirteen of the 16 patients tested positive for marijuana and 3 patients tested positive for
cocaine. Only one patient tested positive for a combined use of both marijuana and
cocaine. This study showed that, in an interventional
pain management setting, there is significant use of
illicit drugs (16%) with 13% use of marijuana and 3% use of
cocaine in patients who are considered as non-abusers of prescription
controlled substances and those who are adherent to
controlled substance agreements. However, if
cocaine is considered as a hardcore
drug in contrast to
marijuana, abuse of hardcore
illicit drugs is only 3%.