Pain clinicians' rankings of aberrant drug-taking behaviors

A pilot study was conducted to examine experienced pain physicians' perceptions of aberrant drug taking behaviors. One hundred pain physicians attending a meeting on pain management were asked to rank order (from most aberrant = 1 to least aberrant = 13) a list of aberrant drug-taking behaviors. The sample was comprised mainly of anesthesiologists (50%) and half of the group had 10 or more years of pain management experience. The group prescribed an average of 19-96 opioid medications per week. Practice variables were not related to the rank ordering of the behaviors. All of the various behaviors appeared in all 13 of the rank ordering slots, suggesting a great deal of individual difference in the perception of these behaviors. By examining the average ranking of the behaviors, we noted that physicians' focus on illegal behaviors as the most aberrant followed by the alteration of route of delivery and self-escalation of dose. This survey suggests that an experienced group of pain clinicians does not view aberrant drug related behaviors uniformly. Average rankings suggest clinicians seem to view illegal behavior as the most worrisome. These results must be interpreted with caution due to the small convenience sample, the lack of data on the level of addiction medicine training of the respondents and the lack of data on those physicians who chose not to respond. Further inquiry could be used to guide clinicians' responses to aberrant behaviors when encountered in patients on controlled substances for pain.