Development of a Screening Tool to Detect the Risk of Inappropriate Prescription Opioid Use in Patients with Chronic Pain

Abstract

Effective use of opioids in patients with chronic pain has been hindered by their potential for drug abuse. There are no reliable means to distinguish those who use the opioids in an inappropriate manner from those who do not. To develop a screening tool to distinguish patients at risk for inappropriate prescription opioid use among patients with chronic pain. We conducted a case-control study of adults with chronic pain. Patients dismissed from the pain clinic for inappropriate prescription opioid use were placed in the "inappropriate opioid use group". Randomly chosen patients with chronic pain on opioids, who did not have any evidence of inappropriate use were in the "control group". We performed a review of the clinical notes of all the patients enrolled in the study and extracted clinical criteria. We analyzed these criteria to identify independent predictors of inappropriate opioid use. Based on these criteria, a screening tool was developed to stratify patients into low-and high-risk categories. This screening tool was then applied to both groups. There were 107 patients in the inappropriate use group and 103 patients in the control group. On multivariate analysis, six criteria were significantly associated with inappropriate drug abuse. These included focus on opioids, opioid overuse, other substance use, nonfunctional status, unclear etiology of pain, and exaggeration of pain. A screening tool was developed by giving one point to each of these criteria so that a patient's score can range from 0 to 6. In the "inappropriate opioid use" group, 77% of patients scored more than 3 points as opposed to 16% in the control group. In the "inappropriate opioid use group", 23% scored 3 or less, in comparison to 84% in the control group. We have identified six clinical criteria, which were significantly more prevalent in the 'inappropriate opioid use group'. Using these criteria, we have developed a screening tool that appears to predict inappropriate use of prescription opioids in patients with chronic pain.