Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool.

OBJECTIVE To provide clinicians with a brief screening tool to predict accurately which individuals may develop aberrant behaviors when prescribed opioids for chronic pain. DESIGN One hundred and eighty-five consecutive new patients treated in one pain clinic took the self-administered Opioid Risk Tool (ORT). The ORT measured the following risk factors associated in scientific literature with substance abuse: personal and family history of substance abuse; age; history of preadolescent sexual abuse; and certain psychological diseases. Patients received scores of 0-3 (low risk), 4-7 (moderate risk), or >or= 8 (high risk), indicating the probability of their displaying opioid-related aberrant behaviors. All patients were monitored for aberrant behaviors for 12 months after their initial visits. RESULTS For those patients with a risk category of low, 17 out of 18 (94.4%) did not display an aberrant behavior. For those patients with a risk category of high, 40 out of 44 (90.9%) did display an aberrant behavior. The authors used the c statistic to validate the ORT, because it simultaneously assesses sensitivity and specificity. The ORT displayed excellent discrimination for both the male (c = 0.82) and the female (c = 0.85) prognostic models. CONCLUSION In a preliminary study, among patients prescribed opioids for chronic pain, the ORT exhibited a high degree of sensitivity and specificity for determining which individuals are at risk for opioid-related, aberrant behaviors. Further studies in a variety of pain and nonpain settings are needed to determine the ORT's universal applicability.

[1]  M. Bohman.  Some genetic aspects of alcoholism and criminality. A population of adoptees. , 1978, Archives of general psychiatry.

[2]  D S Rae,et al.  Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. , 1990, JAMA.

[3]  P Bebbington,et al.  Nicotine, alcohol and drug dependence, and psychiatric comorbidity--results of a national household survey , 2003, The British journal of psychiatry : the journal of mental science.

[4]  L. Manchikanti,et al.  Prevalence of opioid abuse in interventional pain medicine practice settings: a randomized clinical evaluation. , 2001, Pain physician.

[5]  Sunil J Rao,et al.  Regression Modeling Strategies: With Applications to Linear Models, Logistic Regression, and Survival Analysis , 2003 .

[6]  M. F. Fuller,et al.  Practical Nonparametric Statistics; Nonparametric Statistical Inference , 1973 .

[7]  C. Taylor,et al.  The measurement of opiate dependence. , 1986, British journal of addiction.

[8]  E. DeLong,et al.  Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. , 1988, Biometrics.

[9]  H. Tennen,et al.  Validity of the SCID in substance abuse patients. , 1996, Addiction.

[10]  T. Germanson,et al.  The prevalence of psychiatric disorders in patients with alcohol and other drug problems. , 1988, Archives of general psychiatry.

[11]  R. Cadoret,et al.  Specific familial transmission in substance abuse. , 1988, The International journal of the addictions.

[12]  S. Faraone,et al.  Genetic influences on DSM-III-R drug abuse and dependence: a study of 3,372 twin pairs. , 1996, American journal of medical genetics.

[13]  O. Papasouliotis,et al.  A two-item screening test for alcohol and other drug problems. , 1997, The Journal of family practice.

[14]  R. Portenoy,et al.  Opioid therapy for chronic nonmalignant pain: a review of the critical issues. , 1996, Journal of pain and symptom management.

[15]  A. Bifulco,et al.  Early Sexual Abuse and Clinical Depression in Adult Life , 1991, British Journal of Psychiatry.

[16]  Daniel B. Mark,et al.  TUTORIAL IN BIOSTATISTICS MULTIVARIABLE PROGNOSTIC MODELS: ISSUES IN DEVELOPING MODELS, EVALUATING ASSUMPTIONS AND ADEQUACY, AND MEASURING AND REDUCING ERRORS , 1996 .

[17]  S. Schnoll,et al.  Abuse Liability in Opioid Therapy for Pain Treatment in Patients With an Addiction History , 2002, The Clinical journal of pain.

[18]  M Davies,et al.  The Structured Clinical Interview for DSM-III-R (SCID). II. Multisite test-retest reliability. , 1992 .

[19]  H. Belcher,et al.  Substance abuse in children: prediction, protection, and prevention. , 1998, Archives of pediatrics & adolescent medicine.

[20]  S. Passik,et al.  The need to identify predictors of aberrant drug-related behavior and addiction in patients being treated with opioids for pain. , 2003, Pain medicine.

[21]  M. Bohman.  C. SOME GENETIC ASPECTS OF ALCOHOLISM:AN ADOPTEE STUDY , 1981 .

[22]  D. W. Goodwin.  Alcoholism and genetics. The sins of the fathers. , 1985, Archives of general psychiatry.

[23]  K. Merikangas,et al.  Comorbidity for alcoholism and depression. , 1990, The Psychiatric clinics of North America.

[24]  P. Zickler.  Twin Studies Help Define the Role of Genes in Vulnerability to Drug Abuse , 1999 .

[25]  M. First,et al.  The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description. , 1992, Archives of general psychiatry.

[26]  P. Vernon,et al.  Alcohol and drug problems: a multivariate behavioural genetic analysis of co-morbidity. , 1995, Addiction.

[27]  D S Rae,et al.  Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults. , 1988, The American journal of psychiatry.

[28]  S. Savage.  Assessment for Addiction in Pain-Treatment Settings , 2002, The Clinical journal of pain.

[29]  M. Schuckit.  New findings in the genetics of alcoholism. , 1999, JAMA.

[30]  K. Miotto,et al.  Screening for addiction in patients with chronic pain and "problematic" substance use: evaluation of a pilot assessment tool. , 1998, Journal of pain and symptom management.

[31]  J. Ewing,et al.  Detecting alcoholism. The CAGE questionnaire. , 1984, JAMA.

[32]  F. Harrell,et al.  Prognostic/Clinical Prediction Models: Multivariable Prognostic Models: Issues in Developing Models, Evaluating Assumptions and Adequacy, and Measuring and Reducing Errors , 2005 .

[33]  K. Kendler,et al.  Sex-specific genetic influences on the comorbidity of alcoholism and major depression in a population-based sample of US twins. , 2000, Archives of general psychiatry.

[34]  S. Stocker.  Medications Reduce Incidence of Substance Abuse Among ADHD Patients , 1999 .

[35]  W. Overton,et al.  Comorbid adolescent substance abuse: a maladaptive pattern of self-regulation. , 1992, Adolescent psychiatry.

[36]  M. Tsuang,et al.  Co-occurrence of abuse of different drugs in men: the role of drug-specific and shared vulnerabilities. , 1998, Archives of general psychiatry.

[37]  David W. Hosmer,et al.  Applied Logistic Regression , 1991 .

[38]  D. Metzger,et al.  The Fifth Edition of the Addiction Severity Index. , 1992, Journal of substance abuse treatment.

[39]  G. Staines,et al.  Polysubstance Use Among Alcoholics , 2001, Journal of addictive diseases.

[40]  M. Schuckit,et al.  Biological, psychological and environmental predictors of the alcoholism risk: a longitudinal study. , 1998, Journal of studies on alcohol.

[41]  H. Skinner,et al.  Diagnostic validity of the drug abuse screening test in the assessment of DSM-III drug disorders. , 1989, British journal of addiction.

[42]  M. Erjavec,et al.  Prescription opiate abuse in chronic pain patients: clinical criteria, incidence, and predictors. , 1997, The Clinical journal of pain.

[43]  S. Passik,et al.  Pain Clinicians' Rankings of Aberrant Drug-Taking Behaviors , 2002, Journal of pain & palliative care pharmacotherapy.

[44]  A T McLellan,et al.  An Improved Diagnostic Evaluation Instrument for Substance Abuse Patients: The Addiction Severity Index , 1980, The Journal of nervous and mental disease.

[45]  G. Herbison,et al.  Childhood Sexual Abuse and Mental Health in Adult Life , 1993, British Journal of Psychiatry.

[46]  S. Schnoll,et al.  Substance abuse. , 1989, JAMA.

[47]  F. J. Evans,et al.  New Data from the Addiction Severity Index Reliability and Validity in Three Centers , 1985, The Journal of nervous and mental disease.

[48]  S. Butler,et al.  Validation of a screener and opioid assessment measure for patients with chronic pain , 2004, Pain.

[49]  C. Prescott.  Sex Differences in the Genetic Risk for Alcoholism , 2002, Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism.

[50]  K. Kendler,et al.  Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis. , 2000, Archives of general psychiatry.

[51]  K. Rothman.  Epidemiology: An Introduction , 2002 .

[52]  S. Atluri,et al.  Development of a screening tool to detect the risk of inappropriate prescription opioid use in patients with chronic pain. , 2004, Pain physician.

[53]  D. Rae,et al.  Increased rates of drug abuse and dependence after onset of mood or anxiety disorders in adolescence. , 1994, Hospital & community psychiatry.

[54]  K. Riccardi,et al.  The RAFFT as a Screening Tool for Adult Substance Use Disorders , 2002, The American journal of drug and alcohol abuse.