Because our cup runneth over. Not only has our small journal club, here, finally gotten a copy of the paper to study, but I’ve also discovered that a Continuing Medical Education (CME) course has already, in August, been created and put on sale based on a paper published in July. Wow! Weird. More about the CME in my next blog post. For now, here is the cite, link to abstract html page which has link to full text pdf:

http://www.doctordeluca.com/Library/Pain/ SudInChronicPainOpioidRx07.htm

Substance Use Disorders in a Primary Care Sample Receiving Daily Opioid Therapy. Fleming, M.F.; Balousek, S.L.; Klessig, C.L.; Mundt, M.P.; Brown, D.P.; Journal of Pain; 8(7): 573-582; 2007-07.

Dig in, Friends, enjoy! I’ll give it a careful read after I finish posting all this stuff. I think there are interesting flaws and some interesting data and I will be interested to get your takes on the ‘instant CME’ phenomenon, too.

..alex…

It’s one for you, thirty-four for me! Remember, the generals have one. And I’ll advocate for that one. Their pain should be treated. But the news is spreading fast: Now the 3.8% is a “High Frequency of Opioid Use Disorders…” ( http://tinyurl.com/2f9pde ). Indeed…absolutely astronomical! Did anyone mention that “The rate of toxicology tests positive for illicit drug use was 24%”?

The wonders of statistics abound: “…and 4 aberrant drug behaviors (OR = 11.48; 6.13 to 21.48). The final model for opioid use disorders was limited to aberrant behaviors (OR = 48.27; 13.63 to 171.04) as the other variables dropped out of the model.”
( from http://tinyurl.com/yrocew )

It would be funny if the “4 aberrant behaviors” turned out to actually be the DSM-IV criteria. Surely not. The abstract doesn’t say how the logistic regression model was developed. Usually, it is either sequential or statistical, but since they use the term “dropped out” it may have been some variation on statistical (stepwise). Hopefully not (see Thompson, B. (1989). Why won’t stepwise methods die? Measurement and Evaluation in Counseling and Development, 21(4), 146-148). It very well could have been a more advanced method for generating models. The full text should illuminate. If it was stepwise, that would mean the other predictors overlapped with the aberrant behaviors, but the aberrant behaviors were favored because of higher raw initial association, which would make a lot of sense if the behaviors were tied closely to the DSM-IV criteria. That fact in no way makes them better explanatory variables, though. If it was sequential, then that means the researcher just liked the behaviors better than the other variables. The competing variables that “dropped out” were the usual suspects — that would be 18-30 years old, positive for cocaine or marijuana, psychiatric disorder history, etc. That doesn’t even address living in Wisconsin, or what kinds of generals there are in Wisconsin. Are there military bases there?

I can’t get to this on any of my databases, so I’ll reserve further comment until I can read it!

“considering the potential benefit to improving the lives of patients with chronic pain, a 3.8-percent rate of opioid addiction is a small risk compared with the alternative of continuous pain and suffering.” ( from http://tinyurl.com/yqh8ga )

Apparently, causality is assumed because there is a “risk” from therapy, although the authors apparently are on our side, and do not intend the result to be used for opioid fear mongering.