Identifying prescription opioid use disorder in primary care: Diagnostic characteristics of the Current Opioid Misuse Measure (COMM)

Abstract

The Current Opioid Misuse Measure (COMM), a self-report assessment of past-month aberrant medication-related behaviors, has been validated in specialty pain management patients. The performance characteristics of the COMM were evaluated in primary care (PC) patients with chronic pain. It was hypothesized that the COMM can identify patients with prescription drug use disorder (PDD). English-speaking adults awaiting PC visits at an urban, safety-net hospital, who had chronic pain and had received any opioid analgesic prescription in the past year were administered the COMM. The Composite International Diagnostic Interview served as the “gold-standard”, using DSM-IV criteria for PDD and other substance use disorders (SUDs). A receiver operating characteristics (ROC) curve demonstrated the COMM’s diagnostic test characteristics. Of the 238 participants, 27 (11%) met DSM-IV PDD criteria, while 17 (7%) had other SUDs, and 194 (82%) had no disorder. The mean COMM score was higher in those with PDD than among all others (i.e., those with other SUDs or no disorder, mean 20.4 [SD 10.8] vs. 8.4 [SD 7.5], p<0.0001). A COMM score of ≥13 had a sensitivity of 77% and a specificity of 77% for identifying patients with PDD. The area under the ROC curve was 0.84. For chronic pain patients prescribed opioids, the development of PDD is an undesirable complication. Among PC patients with chronic pain prescribed prescription opioids, the COMM is a promising tool for identifying those with PDD.

Tratamiento con opiodes en dolor crónico no oncológico: Recomendaciones para una prescripción segura

“…Esta escala ayuda a identificar a aquellos pacientes tratados con opioides que los estań usando de forma incorrecta; fue validada en pacientes tratados con opioides durante una media de 5,7 años (37,20). La escala COMM es una autoevaluación breve desarrollada con el asesoramiento de un grupo de expertos en dolor y adicciones.…”

Instruments to Identify Prescription Medication Misuse, Abuse, and Related Events in Clinical Trials: An ACTTION Systematic Review

“…7 In 2 studies, the sensitivity and specificity were maximized with a cutoff score of $9 of 68, 6,7 whereas a higher cutoff score of $13 of 68 maximized these values in a third study. 41 Meltzer et al 41 also found higher COMM scores in patients with chronic pain who had a prescription drug use disorder than in those who did not have the disorder, supporting the construct validity of the instrument.…”

“…A cutoff score of $9 yields a sensitivity of 71% and a specificity of 71% (same criterion). Meltzer et al 41 Primary care patients with chronic pain (N = 238) Significantly higher COMM score in patients with prescription drug use disorder than those without. ROC analysis yielded an AUC of .84 (criterion is DSM-IV prescription drug use disorder).…”

“…6,7 The area under the curve in receiver operating characteristic analyses using different gold standard criteria for classifying inappropriate medication use and patients with chronic pain recruited from different clinical settings has likewise been high. 6,7,41 One study demonstrated the COMM's ability to detect change in misuse status after 3 months. 7 In 2 studies, the sensitivity and specificity were maximized with a cutoff score of $9 of 68, 6,7 whereas a higher cutoff score of $13 of 68 maximized these values in a third study.…”

Opioid Analgesic Use Disorders Among Adolescents in the United States

“…Early interventions can prevent the problem from worsening, and attention to the risk factors highlighted herein could compliment or refine the use of tools that screen for opioid addiction (Adams et al, 2004;Fleming, Balousek, Klessig, Mundt, & Brown, 2007;Meltzer et al, 2011) in order to increase the currently low attention (Haller & Acosta, 2010) paid to early detection of OAUD. Haller and Acosta (2010) suggest using psychiatric or substance abuse consultants in order to help identify persons (adolescents in schools, in this case) who may be at greatest risk for OAUD, and then offering brief behavioral interventions or on-site therapy in order to prevent problem occurrence or escalation.…”