OBJECTIVE: Is it safe to treat patients with opioids for chronic non-malignant pain who have histories of substance abuse or addicition? Mortality rates for substance abusers are three times the general population rate. There are few outcome studies in the medical literature. The Opioid Renewal Clinic follows patients closely with drug testing, laboratory monitoring, and provides group education with outside speakers. On site drug counseling is provided to those determined to be in need. A full range of consultation services are available. The disciplines that make up the clinc include Pharmacy, Nursing, Social Work, Internal and Addiction Medicine. Disease management guidelines are incorporated into the structure of the clinic. METHODS:This was a retrospective age adjusted mortality study of 250 Primary Care consults over a two-year period to a multidisciplinary Opioid Renewal Clinic. The most common reason for consultation was the difficult to manage patient secondary to substance abuse. The renewal clinic maintains between 80 to 100 patients. Kaplan-Meier survival curves were performed for pain patients on opioids in Primary Care and the opioid renewal clinic. Key variables were evaluated by regression analysis. RESULTS:There were six deaths in patients in Primary Care and two deaths in patients followed in the Renewal Clinic. The odds ratio of deaths in usual care to clinic is three, or three times the rate of the Renewal Clinic. Patients were between 40-60 years of age. Deaths due to known cancer, cardiac or liver disease were excluded. Cancer deaths were predominantly lung, and assosciated with tobacco use. CONCLUSIONS: A Multidisciplinary Opioid Renewal Clinic can reduce short term mortatlity in high risk patients. Further studies are recommended to assess long term mortality rates and secondary outcomes on cancer prevention, disease management, and control of depression.