Detecting aberrant opioid behavior in the emergency department: a prospective study using the screener and Opioid Assessment for Patients with Pain-Revised (SOAPP®-R), Current Opioid Misuse Measure (COMM)™, and provider gestalt

Shawn M. Varney, Crystal A. Perez, Allyson A. Araña, Katherine R. Carey, Victoria J. Ganem, Lee A. Zarzabal, Rosemarie G. Ramos, Vikhyat S. Bebarta

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Emergency department (ED) providers have limited time to evaluate patients at risk for opioid misuse. A validated tool to assess the risk for aberrant opioid behavior may mitigate adverse sequelae associated with prescription opioid misuse. We sought to determine if SOAPP-R, COMM, and provider gestalt were able to identify patients at risk for prescription opioid misuse as determined by pharmacy records at 12 months. We conducted a prospective observational study of adult patients in a high volume US ED. Patients completed the SOAPP-R and COMM, and treating EM providers evaluated patients’ opioid misuse risk. We performed variable-centered, person-centered, and hierarchical cluster analyses to determine whether provider gestalt, SOAPP-R, or COMM, or a combination, predicted higher misuse risk. The primary outcome was the number of opioid prescriptions at 12 months according to pharmacy records. For 169 patients (mean age 43 years, 51% female, 73% white), correlation analysis showed a strong relationship between SOAPP-R and COMM with predicting the number of opioid prescriptions dispensed at 12 months. Provider scores estimating opioid misuse were not related to SOAPP-R and only weakly associated with COMM. In our adjusted regression models, provider gestalt and SOAPP-R uniquely predicted opioid prescriptions at 6 and 12 months. Using designated cutoff scores, only SOAPP-R detected a difference in the number of opioid prescriptions. Cluster analysis revealed that provider gestalt, SOAPP-R, and COMM scores jointly predicted opioid prescriptions. Provider gestalt and self-report instruments uniquely predicted the number of opioid prescriptions in ED patients. A combination of gestalt and self-assessment scores can be used to identify at-risk patients who otherwise miss the cutoff scores for SOAPP-R and COMM.

Original languageEnglish (US)
Pages (from-to)1239-1247
Number of pages9
JournalInternal and Emergency Medicine
Volume13
Issue number8
DOIs
StatePublished - Dec 1 2018

Keywords

  • Aberrant opioid behavior
  • Current Opioid Misuse Measure (COMM)
  • Emergency department
  • Gestalt
  • Military
  • Prescription opioid misuse
  • Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R)

ASJC Scopus subject areas

  • Internal Medicine
  • Emergency Medicine

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