Taking Control: Emerging Issues in Pain ... - Pharmacy Times

Assessment of Addiction Risk
• Screening measures for addiction risk:
• STAR/SISAP
• CAGE AIDD
• Opioid Risk Tool (Emerging Solutions in Pain)
• SOAPP (see painedu.org)
• Psychiatric assessment of risk:
• Chemical
• Psychiatric
• Social/Familial
• Genetic
• Spiritual
Positioning Opioid Therapy
Opioid Risk Tool
Mark each box that applies. Female Male
1. Family history of substance abuse
– Alcohol
– Illegal drugs
– Prescribing drugs
2. Personal history of substance abuse
– Alcohol
– Illegal drugs
– Prescribing drugs
1
2
4
3
4
5
3
3
4
3
4
5
3. Age (mark box if 16-45 years) 1 1
4. History of preadolescent sexual abuse 3 0
5. Psychological disease
– Attention deficit disorder, obsessive compulsive
disorder, bipolar, schizophrenia
– Depression
Scoring: 0-3: low risk; 4-7: moderate risk; ≥8: high risk
2
1
2
1
Webster LR, Webster RM. Pain Med. 2005;6:432-442.
♦No past/current
history of
substance abuse
♦Noncontributory
family history of
substance abuse
♦No major or untreated
psychological
disorder
Stratify Risk
Low Risk Moderate Risk High Risk
♦Significant family
history of
substance abuse
♦Past/co-morbid
psychological
disorder
♦History of treated
substance abuse
♦Active substance
abuse
♦Active addiction
♦Major untreated
psychological
disorder
♦Significant risk
to self and
practitioner
Current Opioid Misuse Measure
(COMM)
• 17-item patient self-assessment : for those
currently on long-term opioid therapy
• S/S intoxication, emotional volatility, poor
response to medications, addiction, healthcare
use patterns, problematic medication behavior
• NOT used prior to therapy
Gourlay DL, et al. Pain Med. 2005;6:107-112.
Meltzer et al. Pain. 2011;152:397-402.
Risk Factors for Aberrant
Behaviors/Harm
Restructuring Therapy
to Reduce Risk
Biological
• Age ≤ 45 years
• Gender
• Family history of
prescription drug
or alcohol abuse
• Cigarette smoking
Psychiatric
• Preadolescent sexual
abuse (in women)
• Major psychiatric
disorder (eg, personality
disorder, anxiety or
depressive disorder,
bipolar disorder)
• Substance use disorder
Social
• Prior legal problems
• History of motor
vehicle accidents
• Poor family support
• Involvement in a
problematic
subculture
• Consider discontinuation of opioid
• Continue opioid but consider reactive strategies to
improve control over drug use:
• Written agreement (“contract”)
• Frequent visits, small quantities
• Long-acting drugs with no rescue doses
• One pharmacy, pill counts, no replacements
or early scripts
• Urine drug screens
• Required referrals
Katz NP, et al. Clin J Pain. 2007;23:103-118; Manchikanti L, et al. J Opioid Manage. 2007;3:89-100. Webster LR,
Webster RM. Pain Med. 2005;6:432-442.