Prescription opioid abuse, chronic pain, and primary care: a Co-occurring Disorders Clinic in the chronic disease model

J Subst Abuse Treat. 2012 Dec;43(4):446-50. doi: 10.1016/j.jsat.2012.08.010. Epub 2012 Sep 11.


Abuse of opioids has become a public health crisis. The historic separation between the addiction and pain communities and a lack of training in medical education have made treatment difficult to provide, especially in primary care. The Co-occurring Disorders Clinic (COD) was established to treat patients with co-morbid chronic pain and addiction. This retrospective chart review reports results of a quality improvement project using buprenorphine/naloxone to treat co-occurring chronic non-cancer pain (CNCP) and opioid dependence in a primary care setting. Data were collected for 143 patients who were induced with buprenorphine/naloxone (BUP/NLX) between June 2009 and November 2011. Ninety-three patients (65%) continued to be maintained on the medication and seven completed treatment and were no longer taking any opioid (5%). Pain scores showed a modest, but statistically significant improvement on BUP/NLX, which was contrary to our expectations and may be an important factor in treatment retention for this challenging population.

MeSH terms

  • Adult
  • Aged
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / therapeutic use
  • Buprenorphine / administration & dosage
  • Buprenorphine / therapeutic use*
  • Buprenorphine, Naloxone Drug Combination
  • Chronic Pain / complications
  • Chronic Pain / drug therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Naloxone / administration & dosage
  • Naloxone / therapeutic use*
  • Narcotic Antagonists / administration & dosage
  • Narcotic Antagonists / therapeutic use
  • Opioid-Related Disorders / complications
  • Opioid-Related Disorders / rehabilitation*
  • Pain Measurement
  • Prescription Drugs / adverse effects
  • Primary Health Care / organization & administration
  • Quality Improvement
  • Retrospective Studies
  • Treatment Outcome


  • Analgesics, Opioid
  • Buprenorphine, Naloxone Drug Combination
  • Narcotic Antagonists
  • Prescription Drugs
  • Naloxone
  • Buprenorphine