Introduction

• Opioids remain essential for pain management but contribute to addiction and overdose crises.In 2022, 82,000 opioid-involved deaths occurred in the United States despite declining prescription rates.

• Chronic pain affects a growing portion of adults, with 61.4 percent reporting persistent pain between 2019 and 2020.

• Polysubstance use, or the concurrent use of multiple substances, increases addiction risk. About 72.8 percent of opioid-positive patients also test positive for another substance.

• The CDC recommends routine drug screening in chronic pain clinics to identify risk patterns and guide safer prescribing.

  
  

  Methods 

  • Study Design: Retrospective cohort study of 200 new patients (July 2022 to February 2024) at Columbia Pain Center. All patients underwent saliva or urine drug screening upon intake

  • Variables: Demographics including age, sex, race, ethnicity, and prior pain medication use

  • Outcome: Positive drug test for opioids, marijuana, or other substances

  • Analysis: associations between demographics and substance positivity were evaluated using regression analysis

    
    

    Results

    After analyzing 200 drug screens:

    • 44.5% of patients tested positive for at least one drug, with opioids and marijuana most frequent (17.5% and 14.5%, respectively). 

    • Gender: Marijuana positivity was higher in males (73%) vs females (27%).

    • Age: Younger patients were more likely to test positive for marijuana (p < 0.01).

    • Race/Ethnicity: Opioid positivity was higher among White patients (21.5%) than African American patients (9.6%).

    • Co-positivity: Marijuana was the most common co-detected substance.

      
      

      
      

      Discussion

      • Substance co-use remains common in chronic pain patients despite prescription monitoring.

      • Younger age and male gender were associated with higher marijuana positivity.

      • Racial differences in opioid positivity suggest potential disparities in prescribing or screening.

      Limitations: 

      • Single-center, retrospective design.

      • Limited sample size.

      Possible underreporting of substance use.