Prescription Opioid Misuse Index in sickle cell patients: A brief questionnaire to assess at-risk for opioid abuse

Abstract

Objective: To develop a survey instrument to identify adult sickle cell disease (SCD) patients on chronic opioid therapy who are at-risk for opioid abuse. Design: Prospective survey and interview.Setting: Adult SCD clinic in a large urban teaching facility.Patients/participants: Convenience sampling of adult patients presenting to the sickle cell clinic.Interventions: None.Main outcome: Primary outcome was “at-risk for opioid misuse,” defined as at least 3/8 “yes” answers (a positive composite score) on the Prescription Opioid Misuse Index (POMI) questionnaire. Secondary outcome was DSM-IV criteria for substance abuse using the DSM IV Diagnostic Interview Schedule.Results: Of the 99 patients who completed the POMI, the mean age was 36 years; 58.6 percent were female, 48 percent were hemoglobin SS (47/99), and 26 percent were SC (26/99). Twenty-four percent (24/99) were identified as at-risk for opioid misuse using the POMI. There were no differences in demographic, SCD genotype, or socioeconomic variables for at-risk versus not-at-risk patients.Conclusion: Twenty-four percent of unselected adult SCD patients on opioids were identified as at-risk for opioid misuse using a quick survey. This may represent as much as 2.5-7 times the national misuse rate. This group of patients may benefit from additional diagnostic and therapeutic interventions to help understand and manage their opioid usage.

Moving Toward a Multimodal Analgesic Regimen for Acute Sickle Cell Pain with Non-Opioid Analgesic Adjuncts: A Narrative Review

“… 48 And while the prevalence of opioid use disorder among sickle cell patients is similar to that of the general public, 49 patients with SCD are at risk for prescription opioid related mortality. 46 , 50 Due to the recurrent nature of VOCs, SCD patients are also frequently exposed to opioids, both in the hospital and at home. 4 , 51 Opioid tolerance – where increased doses of opioids are needed for pain relief – is frequently observed among SCD patients, although the exact prevalence is unknown.…”

Development and feasibility testing of the Comfort Ability Program for sickle cell pain: A patient-informed, video-based pain management intervention for adolescents with sickle cell disease.

“…Poorly managed recurrent episodes of pain, whether acute or chronic, are known to contribute to morbidity and poor quality of life (Darbari, Ballas, & Clauw, 2014). Moreover, uncontrolled SCP can increase risk of opioid dependence (Smith et al, 2019), is associated with poor long-term coping, and requires extensive health care resources to manage (Shah et al, 2019). Similar to children with other chronic pain conditions, individuals with SCD are particularly vulnerable to symptoms of anxiety and depression due in part to the development of feelings of helplessness or hopelessness, negative thought patterns, and fear/anxiety responses.…”