Assessment, stratification, and monitoring of the risk for prescription opioid misuse and abuse in the primary care setting

Abstract

Objectives: To evaluate potential for and incidence of aberrant drug-related behaviors among patients with chronic, moderate-to-severe pain in a primary care setting and to determine investigator compliance with universal precautions (UP) approach to pain management.Design: Open label, multicenter.Setting: Primary care centers (N = 281) across the United States.Patients: Opioid naïve and opioid experienced with chronic, moderate-to-severe pain (N = 1,487).Interventions: Morphine sulfate extended-release capsules for ≤4 months. Tools comprising UP approach were treatment agreement, card for obtaining/tracking prescriptions, Screener and Opioid Assessment for Patients with Pain®-Revised questionnaire, pill counts, pain-patient follow-up tool, investigator assessment/plan, and urine drug screens (UDSs).Outcome measures: Proportion of patients at low, moderate, and high risk of opioid misuse/abuse based on prespecified criteria and investigator judgment, proportion of patients with aberrant drug-related behaviors, and proportion of investigators compliant with UP approach.Results: Patients were primarily white (87 percent), women (57 percent); mean age, 53 years (range, 21-92 years). At baseline, 47 percent were considered low risk for opioid misuse/abuse, 52 percent moderate, and 1 percent high. UDSs were positive for illicit/nonprescribed drugs in a proportion of patients throughout the study. Overall, 64 percent of investigators were compliant with major components of UP approach in ≥75 percent of their patients. However, there was a tendency for investigators to assign risk levels for opioid misuse/abuse as lower than protocol specified.Conclusions: Most patients in these primary care study centers were categorized as at least moderate risk for opioid misuse/abuse at baseline. Most primary care investigators complied with the UP approach to pain management and risk assessment. The completion of the brief training and clinical use of the tools during the study led to retained behavior change, but there was a tendency for investigators to assign lower risk levels than those that were protocol-specified, suggesting a need for better understanding of factors influencing investigator decisions.

Systematic review to determine which validated measurement tools can be used to assess risk of problematic analgesic use in patients with chronic pain

“…Seven tools were identified and reported by 17 studies, [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] with results summarised in Table 2.…”

Evaluating the Risk of Opioid Abuse in Chronic Pain Patients by Addiction Psychiatry Fellows in an Academic Pain Center

“…Studies show that 1% to 85% of patients depicts some form of ADRB leading to the current recommendations of risk reassessment at every visit [7,8]. While several structured opioid refill clinics have been implemented and report mitigation of harm, these findings may not be generalizable.…”

“…Aberrant drug related behavior (ADRB) is a term used to describe patient deviation from safe utilization of prescription opioids and serves as an indicator of risk. ADRB in pain clinics varies among studies and ranges from 1% to 85% [7][8][9][10][11]. Some tools that assess prescription opioid-related risk include the Opioid Compliance Checklist, the ORBIT (opioid related behavior in treatment) scale, the Current Opioid Misuse Measure (COMM), and the prescription drug use questionnaire (PDUQ) [12][13][14][15].…”

At-a-glance - The local response to the Canadian opioid epidemic in the Kingston, Frontenac, and Lennox and Addington communities

“…Although opioid risk assessment tools and treatment contracts have been used to stratify patient risk and prevent opioid overuse in patients who are at risk for dependence, there is little evidence to support suggestions that they actually have an impact on opioid prescribing. [27][28][29] Additional research is needed to explore the longer-term impacts of local programs on opioid culture and local resource utilization among KFLA health care providers, including physicians, allied health practitioners, front-line staff and individuals with opioid experience. For example, Queen's University launched a series of online opioid training modules that were paired with a set of pre-and post-module survey questionnaires.…”