Adapting the Current Opioid Misuse Measure (COMM) for people with chronic pain and disability due to arthritis: The development of the COMM 11-PWDA

Abstract

BackgroundPeople with arthritis, a leading cause of disability, may be prescribed long-term opioid therapy to manage chronic pain. Regular use of opioids can increase risk of overdose and opioid use disorder (OUD). ObjectiveThe purpose of our research was to validate an instrument to screen for harmful opioid use in people with disability and chronic pain due to arthritis (PWDA). MethodsWe tested the Current Opioid Misuse1 Measure (COMM), an instrument designed for monitoring people with chronic pain on long-term opioids, with 318 PWDA who are taking long term opioids from February–June 2020. We validated the COMM against a Diagnostic and Statistical Manual for Mental Health Disorders, 5th edition (DSM-V) assessment instrument and risk factors for OUD. Final item selection was based on advisory group input, cognitive testing, and empirical evaluation of items. We calculated a cutoff score using receiver operating characteristic (ROC) analysis. ResultsOf the 17 items on the original COMM, we found that 11 items measured the intended construct–opioid use in a way that causes harm in PWDA. Once limiting the instrument to these 11 items (The COMM 11-PWDA), the items had excellent internal consistency and validity with the DSM-V measure. Reasonable sensitivity and specificity were established. ConclusionsThe COMM 11-PWDA is a valid instrument for screening for and monitoring harmful opioid use in PWDA.