Opioid-Related Risk Screening Measures for the Emergency Care Setting

Abstract

Efforts to minimize the impact of prescribed opioids on future adverse outcomes are reliant on emergency care providers' ability to screen and detect opioid use disorder (OUD). Many prescriptions are initiated in the emergency department (ED) for acute pain; thus, validated measures are especially needed. Our systematic review describes the available opioid-related screening measures identified through search of the available literature. Measures were categorized by intent and applied clinical setting. We found 44 articles, identifying 15 screening measures. Of these, nine were developed to screen for current opioid misuse and five to screen for risk of future opioid misuse. None were created for use outside of a chronic pain setting. Many measures were applied differently from intended purpose. Although several measures are available, screening for adverse opioid outcomes in the ED is hampered by lack of validated instruments. Development of clarified conceptual models and ED-specific research is necessary to limit OUD.

Screening for problematic opioid use in the emergency department: Comparison of two screening measures

“…Previous reports of OUD in the ED have been limited by sampling methods and measures not validated in the ED. 9 We sought to randomly approach patients at three Midwestern US EDs and used two measures to identify OUD, allowing comparison of screening methods.…”

“…Yet, patients with SUD may not access healthcare beyond sporadic emergency care visits; thus, the identification of SUD in the ED can play a role in the prevention and treatment response to the current epidemic. Efforts in identifying SUD in the ED leverage models such as the Substance Abuse and Mental Health Services Administration Screening, Brief Intervention, and Referral to Treatment have been implemented; however, these methods require feasible screening methods to identify persons endorsing symptoms of OUD 8,9 . There is a critical need to identify and implement rigorous and practical screening methods for identifying individuals with OUD in the ED.…”

“…The fundamental first step in determining the resources needed to implement a rigorous intervention program for OUD is to develop a clinically feasible and accurate measure to identify those with OUD. Previous reports of OUD in the ED have been limited by sampling methods and measures not validated in the ED 9 . We sought to randomly approach patients at three Midwestern US EDs and used two measures to identify OUD, allowing comparison of screening methods.…”

Genetic Variants Associated With Opioid Use Disorder

“…[6][7][8] To date, there are no validated screening tools to identify which patients are at risk for development of OUD when initiating opioid therapy. 9 Understanding the risk of OUD, and the factors that contribute to it, is imperative to allow for a more informed approach when prescribing opioids.…”

“…Additionally, although millions of people are prescribed opioids each year, only 0.6% of the population reported OUD in 2019 and there is no agreement regarding the level of opioid exposure that is related to risk for development of OUD 6–8 . To date, there are no validated screening tools to identify which patients are at risk for development of OUD when initiating opioid therapy 9 . Understanding the risk of OUD, and the factors that contribute to it, is imperative to allow for a more informed approach when prescribing opioids.…”