The SISAP: A New Screening Instrument for Identifying Potential Opioid Abusers in the Management of Chronic Nonmalignant Pain Within General Medical Practice

Abstract

BACKGROUND:Many physicians are overly cautious about prescribing opioids for chronic pain because of fears of iatrogenic addiction. However, in patients with chronic pain, addiction to opioid analgesics is exceedingly rare when there is no prior history of alcohol or drug abuse.OBJECTIVE:To validate an instrument that separates possible opioid abusers from those who are at low risk.DESIGN/METHODS:The Screening Instrument for Substance Abuse Potential (SISAP) was designed to identify individuals with a possible substance abuse history quickly and accurately. It is based on the National Alcohol and Drug Use Survey (n=9915). Using the first half of the sample (n=4967), two previously validated alcohol use items were combined with three illicit drug use items. These five questions identified those with a history of alcohol and/or illicit drug use.RESULTS:Using the second half of the sample (n=4948), the validation procedure showed that the five combined items correctly classified 91% of substance abusers and had a low rate of false negatives.DISCUSSION:The SISAP is brief and resistant to misrepresentation or falsification. The SISAP is expected to improve pain management by facilitating focus on the appropriate use of opioid analgesics and therapeutic outcomes in the majority of patients who are not at risk of opioid abuse, while carefully monitoring those who may be at greater risk.

Issues in Long-term Opioid Therapy: Unmet Needs, Risks, and Solutions

“…24 For example, smoking is a risk factor for substance abuse because approximately 75% to 95% of patients being treated for a substance abuse disorder smoke, 26 and 2 leading screening tools have linked smoking to aberrant behaviors in patients with pain. 25,27 Patients who have risk factors or are determined through the clinical screening tools to be at high risk should not necessarily be excluded from opioid pharmacotherapy if such treatment has been determined to be the best course of action. However, these patients should begin taking an opioid medication only after a highly structured treatment plan has been created to encompass all aspects of the risk management package discussed herein, particularly strict and frequent monitoring.…”

“…It identifies at-risk patients through inquiries about age and drug, alcohol, and cigarette use; however, SISAP lacks questions about psychiatric comorbidities. 27 Although many validated tools are available, the choice of the appropriate tool often depends on the needs of each practice. For example, ORT is a short, self-administered test that can be used quickly and easily in a busy primary care practice, whereas SOAPP is a slightly longer test, factoring in more complex variables that may be better suited to a specialty practice.…”

Development and validation of the Current Opioid Misuse Measure

“…Chabal et al (1997) developed a prescription abuse checklist of five criteria; patients who meet three of the five criteria are considered to be opiate abusers. Other measures include the Screening Instrument for Substance Abuse Potential (SISAP; Coambs et al, 1996), the Pain Assessment and Documentation Tool (PADT; Passik et al, 2004) and the Pain Medication Questionnaire (PMQ; Adams et al, 2004). While the authors of these measures report that some items distinguish patients currently abusing their medications from those who are not abusing their medications, none have undergone prospective testing such as that recommended by Robinson et al (2001), and no one scale has been determined to be superior in assessing opioid abuse .…”

Opioid Analgesics

“…Some of the most commonly recommended tools include the Screener and Opioid Assessment for Patients with Pain e Revised, [72][73][74] the Opioid Risk Tool, 75,76 the Diagnosis, Intractability, Risk, and Efficacy scale, 77 and the Screening Instrument for Substance Abuse Potential. 78 Validated ongoing assessment measures have also been useful in identifying current opioid abuse (Current Opioid Misuse Measure 79,80 and Opioid Compliance Checklist 81 ). Scores on any of these measures are not necessarily a reason to deny opioids but instead allow clinicians to identify patients in whom close monitoring might be required to minimize their likelihood of opioid abuse and addiction.…”