Abstract
Emergency department (ED) providers have limited time to evaluate patients at risk for opioid misuse. A validated tool to assess the risk for aberrant opioid behavior may mitigate adverse sequelae associated with prescription opioid misuse. We sought to determine if SOAPP-R, COMM, and provider gestalt were able to identify patients at risk for prescription opioid misuse as determined by pharmacy records at 12 months. We conducted a prospective observational study of adult patients in a high volume US ED. Patients completed the SOAPP-R and COMM, and treating EM providers evaluated patients’ opioid misuse risk. We performed variable-centered, person-centered, and hierarchical cluster analyses to determine whether provider gestalt, SOAPP-R, or COMM, or a combination, predicted higher misuse risk. The primary outcome was the number of opioid prescriptions at 12 months according to pharmacy records. For 169 patients (mean age 43 years, 51% female, 73% white), correlation analysis showed a strong relationship between SOAPP-R and COMM with predicting the number of opioid prescriptions dispensed at 12 months. Provider scores estimating opioid misuse were not related to SOAPP-R and only weakly associated with COMM. In our adjusted regression models, provider gestalt and SOAPP-R uniquely predicted opioid prescriptions at 6 and 12 months. Using designated cutoff scores, only SOAPP-R detected a difference in the number of opioid prescriptions. Cluster analysis revealed that provider gestalt, SOAPP-R, and COMM scores jointly predicted opioid prescriptions. Provider gestalt and self-report instruments uniquely predicted the number of opioid prescriptions in ED patients. A combination of gestalt and self-assessment scores can be used to identify at-risk patients who otherwise miss the cutoff scores for SOAPP-R and COMM.
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References
Manchikanti L, Fellows B, Ailinani H, Pampati V (2010) Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective. Pain Physician 13:401–435
The American Society of Interventional Pain Physicians Fact Sheet. https://www.asipp.org/documents/ASIPPFactSheet101111.pdf. Accessed 20 Jul 17
Rudd RA, Aleshire N, Zibbell JE, Gladden RM (2014) Increases in drug and opioid overdose deaths—United States, 2000–2014. MMWR January 1, 2016/64(50);1378–1382. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm. Accessed 20 Jul 2017
Rui P, Kang K, Albert M. National Hospital Ambulatory Medical Care Survey: 2013 emergency department summary tables. http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2013_ed_web_tables.pdf. Accessed 3 Jul 2017
Weiner SG, Griggs CA, Mitchell PM, Langlois BK, Friedman FD, Moore RL, Lin SC, Nelson KP, Feldman JA (2013) Clinician impression versus prescription drug monitoring program criteria in the assessment of drug-seeking behavior in the emergency department. Ann Emerg Med 2013(62):281–289
Webster LR, Webster R (2005) Predicting aberrant behaviors in Opioid-treated patients: preliminary validation of the Opioid risk too. Pain Med 6(6):432
Adams LL, Gatchel RJ, Robinson RC et al (2004) Development of a self-report screening instrument for assessing potential opiate medication misuse in chronic pain patients. J Pain Symptom Manage 27:440–459
Butler SF, Budman SH, Fernandez K, Jamison RN (2004) Validation of a screener and opiate assessment measure for patients with chronic pain. Pain 112:65–75
Compton PA, Wu SM, Schieffer B, Pham Q, Naliboff BD (2008) Introduction of a self-report version of the prescription drug use questionnaire and relationship to medication agreement non-compliance. J Pain Symptom Manage 36(4):383–395
Compton P, Darakjian J, Miotto K (1998) Screening for addiction in patients with chronic pain and “problematic” substance use: evaluation of a pilot assessment tool. J Pain Symptom Manage 16:355–363
Butler SF, Budman SH, Fernandez KC et al (2007) Development and validation of the Current Opiate Misuse Measure. Pain 130:144–156
MMWR Recommendations and Reports/Vol. 65/No. 1 18 Mar 16, CDC Guideline for prescribing opioids for chronic pain—United States, 2016. https://www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6501e1.pdf. Accessed on 28 Jun 17
Wu SM, Compton P, Bolus R et al (2006) The addiction behaviors checklist: validation of a new clinician-based measure of inappropriate opiate use in chronic pain. J Pain Symptom Manage 32(4):342–351
Varney SM, Bebarta VS, Mannina LM, Ramos RG, Ganem VJ, Carey KR (2016) Emergency medicine providers’ opioid prescribing practices stratified by gender, age, and years in practice. World J Emerg Med 7(2):106–110
Eichorn D, Lesenskyj A, Maxwell C, Moore S, Cruciani R (2016) (195) The feasibility and value of using the SOAPP-R to predict substance abuse in an outpatient pain clinic. J Pain 17(4S):S24
Weiner SG, Horton LC, Green TC, Butler SF (2016) A comparison of an opioid abuse screening tool and prescription drug monitoring data in the emergency department. Drug Alcohol Depend 159:152–157
Edlund MJ, Martin BC, Russo JE, DeVries A, Braden JB, Sullivan MD (2014) The role of opioid prescription in incident opioid abuse and dependence among individuals with chronic noncancer pain: the role of opioid prescription. Clin J Pain 30:557–564
Zedler B, Xie L, Wang L et al (2014) Risk factors for serious prescription opioid-related toxicity or overdose among Veterans Health Administration patients. Pain Med 15:1911–1929
Finkelman MD, Kulich RJ, Butler SF, Jackson WC, Friedman FD, Smits N, Weiner SG (2016) An investigation of completion times on the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R). J Pain Res 9:1163–1171
Butler SF, Budman SH, Fernandez KC, Fanciullo GJ, Jamison RN (2009) Cross-validation of a Screener to Predict Opioid Misuse in Chronic Pain Patients (SOAPP-R). J Addict Med 3(2):66–73
Greenwood-Ericksen MB, Poon SJ, Nelson LS, Weiner SG, Schuur JD (2016) Best practices for prescription drug monitoring programs in the emergency department setting: results of an expert panel. Ann Emerg Med 67:755–764
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Funding organization: United States Air Force Office of the Surgeon General, October 2012–September 2013.
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Varney, S.M., Perez, C.A., Araña, A.A. et al. Detecting aberrant opioid behavior in the emergency department: a prospective study using the screener and Opioid Assessment for Patients with Pain-Revised (SOAPP®-R), Current Opioid Misuse Measure (COMM)™, and provider gestalt. Intern Emerg Med 13, 1239–1247 (2018). https://doi.org/10.1007/s11739-018-1804-3
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DOI: https://doi.org/10.1007/s11739-018-1804-3