Table 1.

Key Question 3: Differences in Clinical Treatment for Chronic Non-Cancer Pain Based on Substance Use Disorder (SUD) Status.

Reference	Study Design	Setting	Number enrolled	Results	Quality Rating
Kaplan et al. [46]	Open-label treatment study	Inpatients and outpatients with AIDS at 1 of 5 specialty pain service teaching programs	N = 44	More SUD patients were in the high dose opioid group (47%) than low dose opioid group (16%). No difference between groups in the proportion reporting acceptable analgesia (72% non-SUD vs. 67% SUD). SUD patients required higher doses of sustained-release morphine initially and at the final dose (p=.0004).	Poor
Newshan & Lefkowitz [57]	Open-label treatment study	Outpatients with AIDS	N = 35	Patients with SUD history of had lower doses of fentanyl than patients without SUD history (36.1 +/− 19.6 mg/h vs. 62.5 +/− 28.9 mg/h, p<.003)	Poor
Breckenridge & Clark [31]	Retrospective Cohort	A VA Medical Center and an outpatient general medical clinic	N = 200	Patients with SUD were more likely to be prescribed an opioid rather than NSAID (OR=4.7).	Fair
Massey et al. [55]	Retrospective Cohort	Level 1 trauma center. All patients had admission to hospital for high-energy fracture and treated by orthopedics	N = 50	Patients with positive toxicology screens at baseline were more likely to be prescribed opioids 3–6 months after discharge. At 6 months, rate was 53% vs.7% (OR=14.5)	Poor
Whitehead et al. [65]	Retrospective Cohort	Veterans with the hepatitis C virus from the Pacific Northwest	N = 8,224	Of hepatitis C patients with a pain diagnosis, those with history of SUD were less likely to receive opioids in past year (36% vs. 43%, p<0.001) and in past 3 years (56% vs. 60%, p<0.01) than patients without a history of SUD.	Fair
Weisner et al. [64]	Retrospective Cohort	Members of two health plans: Kaiser Permanente of Northern California and Group Health in Washington	All members in both health plans were potentially eligible	Baseline rates for long-term opioid use were higher for those with SUD history than without, and remained higher over time in both health plans (Kaiser, increased from 11.7% to 17.0% for SUD, versus 2.6% to 3.9% for non-SUD; Group Health increased from 7.6% to 18.6% for SUD, versus 2.7% to 4.8% for non-SUD). In both health plans, SUD patients were on higher dose regimens, received more days supply, and were more likely to receive short-and long-acting Schedule II opioids and long-term supplies of sedative-hypnotics, compared to non-SUD patients.	Fair