As opioids become increasingly accepted as an effective form of pain management for some types of chronic pain, doctors are concerned about the use of the opioids and the potential for their abuse. Studies have been done to find ways to identify behaviors of patients who may be prone to abusing opioids if given for chronic pain, but none have been done to develop an assessment for patients who are taking them for an extended length of time.
In this study, investigators took an initial pool of 177 items (statements or questions) that were developed with input from 26 pain management and addiction specialists. The pain experts were doctors, nurses, and psychologists. Twenty-two of the specialists rated the items for importance and relevance. The outcome was a 40-item alpha (first version) COMM, or Current Opioid Misuse Measure.
The patients who were recruited for the one-week study had be adults, receiving treatment currently for chronic, noncancer pain for at least six months, taking opioids for pain relief that were equal to or more than 20 mg of oxycodone per day, and not have any serious psychiatric impairment. These patients had already participated in a previously arranged study and this COMM study was part of the end follow-up of that first study.
The patients were asked to complete the COMM questionnaire and also to complete two other questionnaires. One was the Prescription Drug Use Questionnaire (PDUQ), which asked about pain, opioid use patterns, family and social factors, family history of pain, substance abuse, and psychiatric history. The second was the Marlow-Crowne social desirability scale (M-C). The physicians were asked to complete the Prescription Opioid Therapy Questionnaire (POTQ), which reflected the patients’ behaviors. Patients also supplied a urine sample for testing for evidence of a variety of opioids. The patients were classified on the Aberrant Drug Behavior Index to determine drug-related behavior.
The investigators found that of the 40 items, 17 appeared to be reliable in identifying which chronic pain patients who were currently taking opioids for pain management would show evidence of misuse or abuse of the opioids. A positive aspect of this test was that it was easy to understand and took little effort to score.
The authors point out that the cutoff score that was selected for the COMM was deliberate in order to over-identify misuse, not to mislabel incorrectly. They said, “We believe that it is more important to identify patents who have only a possibility of misusing their medications than to fail to identify those who are actually abusing their medication. Thus, the scale will result in false positives – patients identified as misusing their medications when they were not.”
The investigators note that the COMM is a tool to aid physicians in documenting compliance with the opioids. They say that it is important to have more studies, including a retest of the one-week period and then a three-month repeat as well.