The use of controlled substances to treat pain is associated with the need to monitor carefully patients for signs of addictive behaviors that may lead to the misuse or abuse of medications. At the West Virginia Pain Treatment Center in Morgantown, a narcotic protocol is employed which consists of a narcotic contract, consent, psychological evaluation, and random urinalysis to ensure the safe and proper use of controlled substances. This study reports the findings of a retrospective study of 186 patients at the center from Jan. 1, 2001 to Dec. 31, 2001, which revealed that there were 355 infractions of the narcotic contract. Products containing hydrocodone were found to be most frequently misused (20.3%), followed by oxycodone products (19.7%). Patients prescribed controlled substances should be repeatedly evaluated for medication misuse and the presence of addictive behaviors.