Clinicians recognize the importance of monitoring aberrant medication-related behaviors of chronic pain patients while being prescribed opioid therapy. The purpose of this study was to develop and validate the Current Opioid Misuse Measure (COMM) for those pain patients already on long-term opioid therapy. An initial pool of 177 items was developed with input from 26 pain management and addiction specialists. Concept mapping identified six primary concepts underlying medication misuse, which were used to develop an initial item pool. Twenty-two pain and addiction specialists rated the items on importance and relevance, resulting in selection of a 40-item alpha COMM. Final item selection was based on empirical evaluation of items with patients taking opioids for chronic, noncancer pain (N=227). One-week test-retest reliability was examined with 55 participants. All participants were administered the alpha version of the COMM, the Prescription Drug Use Questionnaire (PDUQ) interview, and submitted a urine sample for toxicology screening. Physician ratings of patient aberrant behaviors were also obtained. Of the 40 items, 17 items appeared to adequately measure aberrant behavior, demonstrating excellent internal consistency and test-retest reliability. Cutoff scores were examined using ROC curve analysis and reasonable sensitivity and specificity were established. To evaluate the COMM's ability to capture change in patient status, it was tested on a subset of patients (N = 86) that were followed and reassessed three months later. The COMM was found to have promise as a brief, self-report measure of current aberrant drug-related behavior. Further cross-validation and replication of these preliminary results is pending.

The original Screener and Opioid Assessment for Patients with Pain (SOAPP) is a conceptually derived self-report questionnaire designed to predict aberrant medication-related behaviors among chronic pain patients considered for long-term opioid therapy. The purpose of this study was to develop and validate an empirically-derived version of the SOAPP (SOAPP-R) that addresses some limitations of the original SOAPP. In successive steps, items were reduced from an initial pool of 142 to a 97-item beta version. The beta version was administered to 283 chronic pain patients on long-term opioid therapy. Items were evaluated based on data collected at follow-up, including correlation with the Aberrant Drug Behavior Index (ADBI), derived from interview data, physician ratings, and urine toxicology screens. Twenty-four items were retained and comprise the final SOAPP-R. Coefficient α was .88, and receiver operating characteristics (ROC) curve analysis yielded an area under the curve (AUC) of .81 (p < .001). A cutoff score of 18 showed adequate sensitivity (.81) and specificity (.68). The obtained psychometrics, along with the use of a predictive criterion that goes beyond self-report, suggest that the SOAPP-R is an improvement over the original version in screening risk potential for aberrant medication-related behavior among persons with chronic pain. Perspective:There is need for a screener for abuse risk in patients prescribed opioids for pain. This study presents a revised version of the Screener and Opioid Assessment for Patients with Pain (SOAPP-R) that is empirically-derived with good reliability and validity, but is less susceptible to overt deception then the original SOAPP v.1.

There has been a need for a brief assessment tool for providers who treat chronic pain patients to determine potential risk of abuse when prescribed opioids for pain. The purpose of this study was to develop and begin the validation of a self-administered screening tool (Screener and Opioid Assessment for Patients with Pain, SOAPP) for chronic pain patients considered for long-term opioid therapy. A consensus of 26 pain and addiction experts was obtained on important characteristics of chronic pain patients that predict future medication misuse using concept mapping. A 24-item SOAPP (version 1.0) was developed based on this consensus and was administered to 175 patients who were taking opioids for chronic pain. After 6 months, 95 of these patients were re-evaluated. Validation of the SOAPP was conducted by identifying those patients exhibiting aberrant drug-related behavior as determined by any of the following: a positive score on the Prescription Drug Use Questionnaire (PDUQ) interview, positive urine toxicology screen, and/or ratings by staff as to whether patients had a serious drug problem. Of the original 24 items, 14 SOAPP items appeared to predict subsequent aberrant behaviors. Coefficient alpha for these 14 items was acceptable for a short scale (0.74). Receiver operating characteristics curve analysis yielded an area under the curve of 0.881 (P<0.001), suggesting adequate sensitivity and specificity for a screening device. These reliability and predictive validity results suggest that the SOAPP is a promising step toward screening risk potential for substance misuse among persons with chronic pain.

This study examined the relationship between DSM-IH-R personality disorders and the interpersonal circumplex and Big Five models of personality traits. One hundred and two consecutive referrals for group therapy for personality disorders were evaluated using the Personality Disorder Examination (PDE) and the Millon Clinical Multiaxial Inventory II (MCMI-II) personality-disorder scales. Their placement in circumplex space was assessed using the Inventory of Interpersonal Problems Circumplex Scales, whereas their standing on the Big Five traits was measured with the 50-Bipoiar Self-Rating Scales (50-BSRS). We found that many disorders could be meaningfully located in circumplex space, whereas the use of the Big Five model led to even better placement for several disorders. Further examination of the residuals from the PDE, after the 50-BSRS scales were partialed out, indicated that the remaining common variance could also be understood in terms of the Big Five model.The third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-///; American Psychiatric Association, 1980) introduced operational definitions of personality disorders that were later refined in the DSM-IH-R (American Psychiatric Association, 1987). It has been pointed out that personality disorders as defined in DSM-IIIand DSM-HI-R bear an ambiguous relationship to trait theories as developed by personality psychologists working with normal populations (Clark, Vorhies, & McEwen, in press). Personality disorders occur "when personality traits are inflexible and maladaptive and cause either significant impairment in social or occupational functioning or subjective distress" (American Psychiatric Association, 1987, p. 335). This formulation may be interpreted as suggesting that personalitydisordered persons should exhibit extremes of traits possessed to a less extreme degree by normals. To examine this question, researchers in personality disorder have been encouraged to relate personality pathology to theories of personality traits developed with normal populations.Although there has been much controversy over the decades regarding the best set of traits to use in investigating personal-

Psychiatric factors, such as a history of mood disorder, psychologic problems, and psychosocial stressors, may place patients at risk for misuse of prescription opioids. Future studies to elucidate the risk of medication misuse and aberrant drug behavior among this patient population are needed.