Validation and threshold identification of a prescription drug monitoring program clinical opioid risk metric with the WHO alcohol, smoking, and substance involvement screening test

Cochran, Gerald; Brown, Jennifer L.; Yu, Ziji; Frede, Stacey M.; Bryan, M. Aryana; Ferguson, A. Stewart; Bayyari, Nadia; Taylor, Brooke; Snyder, Margie E.; Charron, Elizabeth; Adeoye-Olatunde, Omolola A.; Ghitza, Udi E.; Winhusen, Theresa

doi:10.1016/j.drugalcdep.2021.109067

Cited by 19 publications

(3 citation statements)

References 39 publications

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“…A total of 1464 participants were included in the parent study (see Cochran et al. [2021] for detailed enrollment flow chart) 16 ; participants with no missing data on the core measures were included in these analyses ( N = 1268).…”

Section: Methodsmentioning

confidence: 99%

“…Participants who completed the electronic consent form and screened as eligible were then emailed the health survey. A total of 1464 participants were included in the parent study (see Cochran et al [2021] for detailed enrollment flow chart) 16 ; participants with no missing data on the core measures were included in these analyses (N ¼ 1268).…”

Section: Participants and Proceduresmentioning

confidence: 99%

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Associations between Elevated Depressive Symptoms and Substance Use, Prescription Opioid Misuse, Overdose History, Pain, and General Health among Community Pharmacy Patients Prescribed Opioids

et al. 2022

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Background: Individuals with pain prescribed opioids experience high rates of comorbid depression. The aim of this study was to characterize pain, substance use, and health status as a function of depressive symptom level in individuals filling an opioid prescription at a community pharmacy. Methods: Participants (N ¼ 1268) filling an opioid prescription enrolled in a study validating a prescription drug monitoring metric completed an online survey assessing sociodemographics, depressive symptoms, substance use, prescription opioid misuse, overdose history, general health, and pain severity and interference. Results: Approximately one-fifth (19.3%) had a positive depression screen result. In covariate-adjusted logistic regression analyses, individuals with a positive depression screen result were more likely to have moderate/high substance use risk scores for prescription opioids (adjusted odds ratio [AOR] ¼ 2.06; 95% confidence interval [CI], 1.51-2.79); street opioids (AOR ¼ 7.18; 95% CI, 2.57-20.01); cannabis (AOR ¼ 2.00; 95% CI, 1.34-3.00); cocaine (AOR ¼ 3.46; 95% CI, 1.46-8.22); tobacco (AOR ¼ 1.59; 95% CI, 1.18-2.15); methamphetamine (AOR ¼ 7.59; 95% CI, 2.58-22.35); prescription stimulants (AOR ¼ 2.95; 95% CI, 1.59-5.49); and sedatives (AOR ¼ 3.41; 95% CI, 2.43-4.79). Individuals with a positive depression screen were more likely to misuse prescription opioids (AOR ¼ 3.46; 95% CI, 2.33-5.15), experience a prior overdose (AOR ¼ 2.69; 95% CI, 1.76-4.11), report poorer general health (AOR ¼ 0.25, 95% CI, 0.18-0.35), and report moderate/severe pain severity (AOR ¼ 4.36, 95% CI, 2.80-6.77) and interference (AOR ¼ 6.47, 95% CI, 4.08-10.26). Conclusions: Individuals prescribed opioids with heightened depression were more likely to report other substance use, prescription opioid misuse, prior overdose, greater pain, and poorer health.

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Section: Methodsmentioning

confidence: 99%

Section: Participants and Proceduresmentioning

confidence: 99%

Associations between Elevated Depressive Symptoms and Substance Use, Prescription Opioid Misuse, Overdose History, Pain, and General Health among Community Pharmacy Patients Prescribed Opioids

et al. 2022

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“…Risk scores are reportedly generated by applying proprietary algorithms that are not publicly available to information from patient EHRs and other sources such as court records and criminal and sexual trauma histories; these algorithms might disparately affect women, persons of color, and persons who live in poverty ( 302 ). Importantly, whereas one PDMP-generated risk measure has shown fair concurrence with the WHO Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), these scores have not been externally validated against clinical outcomes ( 302 , 303 ). Such risk scores should not take the place of clinical judgment.…”

Section: Recommendationsmentioning

confidence: 99%

CDC Clinical Practice Guideline for Prescribing Opioids for Pain—United States, 2022

Dowell¹,

Ragan²,

Jones³

et al. 2022

MMWR Recomm. Rep.

790

465

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Summary This guideline provides recommendations for clinicians providing pain care, including those prescribing opioids, for outpatients aged ≥18 years. It updates the CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016 (MMWR Recomm Rep 2016;65[No. RR-1]:1–49) and includes recommendations for managing acute (duration of <1 month), subacute (duration of 1–3 months), and chronic (duration of >3 months) pain. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care. The guideline addresses the following four areas: 1) determining whether or not to initiate opioids for pain, 2) selecting opioids and determining opioid dosages, 3) deciding duration of initial opioid prescription and conducting follow-up, and 4) assessing risk and addressing potential harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Recommendations are based on systematic reviews of the scientific evidence and reflect considerations of benefits and harms, patient and clinician values and preferences, and resource allocation. CDC obtained input from the Board of Scientific Counselors of the National Center for Injury Prevention and Control (a federally chartered advisory committee), the public, and peer reviewers. CDC recommends that persons with pain receive appropriate pain treatment, with careful consideration of the benefits and risks of all treatment options in the context of the patient’s circumstances. Recommendations should not be applied as inflexible standards of care across patient populations. This clinical practice guideline is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death.

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Paths Forward for Clinicians Amidst the Rise of Unregulated Clinical Decision Support Software: Our Perspective on NarxCare

Buonora,

Axson,

Cohen

et al. 2023

J GEN INTERN MED

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Validation and threshold identification of a prescription drug monitoring program clinical opioid risk metric with the WHO alcohol, smoking, and substance involvement screening test

Cited by 19 publications

References 39 publications

Associations between Elevated Depressive Symptoms and Substance Use, Prescription Opioid Misuse, Overdose History, Pain, and General Health among Community Pharmacy Patients Prescribed Opioids

Associations between Elevated Depressive Symptoms and Substance Use, Prescription Opioid Misuse, Overdose History, Pain, and General Health among Community Pharmacy Patients Prescribed Opioids

CDC Clinical Practice Guideline for Prescribing Opioids for Pain—United States, 2022

Paths Forward for Clinicians Amidst the Rise of Unregulated Clinical Decision Support Software: Our Perspective on NarxCare

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