Clinical Inquiries

Is there a primary care tool to detect aberrant drug-related behaviors in patients on opioids?

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EVIDENCE-BASED ANSWER:

Yes. Of the several screening instruments developed and originally validated in patients in a pain center population (TABLE), one also has been validated in primary care. The Current Opioid Misuse Measure (COMM) predicts aberrant drug-related behaviors in primary care patients who have been prescribed opioids within the past 12 months with a sensitivity of 77% and specificity of 77% (strength of recommendation [SOR]: B, cohort studies).

Although not validated in primary care populations, 3 other instruments (the Addiction Behaviors Checklist [ABC], Prescription Opioid Misuse Index [POMI], and Prescription Drug Use Questionnaire [PDUQ]) detect aberrant drug-related behaviors in pain center patients with chronic pain with sensitivities of 82% to 87.5% and specificities of 86.14% to 92.3% (SOR: B, cohort studies).

EVIDENCE SUMMARY

The COMM—originally designed to detect recent aberrant drug-related behaviors in pain center patients—was validated by a cross-sectional study involving 238 primary care patients who had been prescribed an opioid within the previous 12 months.1

The study authors defined aberrant drug-related behaviors as meeting the criteria for prescription drug use disorder in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). High COMM scores significantly predicted this diagnosis (P<.001). A COMM cutoff score >13 yielded a sensitivity of 77% and a specificity of 77% (positive predictive value=0.30; negative predictive value=0.96).

Development of the COMM. The authors of the COMM developed questions by expert consensus for use in a population of patients in a pain center. They established the validity of the questions by correlating COMM results from a cohort of pain center patients with 2 previously validated instruments: The Marlowe-Crowne Social Desirability Scale and the Aberrant Drug Behavior Index. They also tested COMM’s validity for monitoring changes in aberrant drug-related behaviors in a second cohort (sensitivity=94%; specificity=73%).2 They later cross-validated COMM with another group of 226 patients treated at pain management clinics, achieving similar results.3

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