Validation of a Brief Opioid Compliance Checklist for Patients With Chronic Pain

Abstract

There has been a need for a brief assessment tool to determine compliance with use of prescribed opioids for pain. The purpose of this study was to develop and begin the validation of a brief and simple compliance checklist (Opioid Compliance Checklist; OCC) for chronic pain patients prescribed long-term opioid therapy. A review of the literature of opioid therapy agreements led to a 12-item OCC that was repeatedly administered to 157 patients who were taking opioids for chronic pain and followed for six months. Validation of the OCC was conducted by identifying those patients exhibiting aberrant drug-related behavior as determined by any of the following: positive urine toxicology screen, a positive score on the Prescription Drug Use Questionnaire (PDUQ) interview or Current Opioid Misuse Measure (COMM), and/or ratings by staff on the Addiction Behavior Checklist (ABC). Of the original 12 items, 5 OCC items appeared to best predict subsequent aberrant behaviors based on multivariate logistic regression analyses (cross-validated AUC=.67). Although further testing is needed, these results suggest that the OCC is an easy-to-use, promising measure in monitoring opioid adherence among persons with chronic pain.

Influence of catastrophizing on pain intensity, disability, side effects, and opioid misuse among pain patients in primary care

“…All patients were contacted by telephone at 1 and 6 months and were asked to complete an assessment of their pain (now, average, worst, least), activity interference (routine daily activity, social and outdoor activity, sleep, appetite, and ability to work), mood, benefit from treatment, and medications side effects for those currently taking opioids. They were also administered the eight‐item Opioid Compliance Checklist ( OCC; Jamison et al., ) as part of their phone interview. On the OCC, the participants answered yes/no questions about their use of opioids that reflected items typically found on an opioid agreement to determine whether they had: (1) taken the opioid medication as prescribed, (2) used only one pharmacy, (3) received opioid medication from only one practitioner, (4) taken precautions not to lose or misplace their opioid medication, (5) not run out of their opioid medication early, (6) kept all scheduled medical appointments, (7) not “borrowed” opioid medication from others, and (8) avoided the use of any illegal or unauthorized substances.…”

“…Any responses which suggested noncompliance were documented. This measure has been shown to have adequate validity and reliability (Jamison et al., ). We have found that any positive “yes” response on the items is predictive of future opioid misuse (Jamison, Martel, et al., ).…”

“…There is also evidence that those patients who are at greatest risk for misuse of opioids are most likely to be prescribed opioids (Caldwell et al., ). The safe use of opioids for treatment of chronic pain has become a particular concern among healthcare providers (Jamison et al., ).…”

Opioid Analgesics

“…Patients are often aware of the risks and complications associated with opioids, and termed conditions are needed to document that the patients are being responsible and benefiting from prescription opioids for pain. 81 Typical sample conditions state that (1) patients should only use their prescribed medications as directed by their physician, (2) they agree to only receive prescription pain medication from one physician, (3) they will only use one pharmacy to fill prescriptions, (4) they will not receive additional medication if their prescription runs out early, (5) they will be unable to receive replacement medication if lost or stolen, (6) they agree to submit to periodic urine screens and pill counts to verify adherence, (7) they will be responsible in maintaining their appointments, (8) they agree to participate in all aspects of treatment (eg, physical therapy, psychotherapy, and behavioral medicine), and (9) if pain and daily function have not improved with their prescription pain medication, the physician has the right to taper the patient off the medication. 2,44,81 Each of the elements of the opioid therapy agreement should be clarified so that patients know exactly what is expected of them.…”

“…Periodic use of an opioid adherence checklist can also be used to remind patients of their responsibilities when using opioids. 81 For some, a violation of this agreement would mean tapering and eventually discontinuing prescription opioids. Unfortunately, violations of this agreement can go unreported, and often, the treating physician has difficulty in tracking and verifying adherence.…”