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Exploring the Psychometric Properties of the Current Opioid Misuse Measure Among Adults With Chronic Pain and Opioid Use. Clin J Pain 2021; 36:578-583. [PMID: 32433073 DOI: 10.1097/ajp.0000000000000846] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The opioid epidemic is a significant public health problem that is associated with overdose and death. The increase in opioid-related problems can largely be attributed to increases in opioid prescriptions for the treatment of chronic pain. Unfortunately, there is not a consensus on a definition of opioid misuse in the context of chronic pain, making measurement a challenge. One commonly used measure to assess opioid misuse in the context of chronic pain is the Current Opioid Misuse Measure (COMM). The COMM was designed to assess opioid misuse generally, as captured by psychiatric symptoms and aberrant drug use behaviors. Although studies have examined cross-validation using correlations, little psychometric work has been conducted, and therefore it is currently unknown what domains the measure is assessing. MATERIALS AND METHODS The current study examined the factor structure of the COMM using confirmatory and exploratory factor analysis among 445 opioid-using adults with chronic pain. RESULTS The results did not support the widely accepted 1-factor opioid misuse solution; rather they supported a 2-factor, psychiatric problems and aberrant-drug-use-problems factor structure. Convergent and divergent validity were also examined at the bivariate level. DISCUSSION Given the importance and relevance for opioid misuse in the context of chronic pain, it is important for researchers to continue assessing and providing psychometric evidence for the COMM.
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Afshar M, Sharma B, Bhalla S, Thompson HM, Dligach D, Boley RA, Kishen E, Simmons A, Perticone K, Karnik NS. External validation of an opioid misuse machine learning classifier in hospitalized adult patients. Addict Sci Clin Pract 2021; 16:19. [PMID: 33731210 PMCID: PMC7967783 DOI: 10.1186/s13722-021-00229-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/10/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Opioid misuse screening in hospitals is resource-intensive and rarely done. Many hospitalized patients are never offered opioid treatment. An automated approach leveraging routinely captured electronic health record (EHR) data may be easier for hospitals to institute. We previously derived and internally validated an opioid classifier in a separate hospital setting. The aim is to externally validate our previously published and open-source machine-learning classifier at a different hospital for identifying cases of opioid misuse. METHODS An observational cohort of 56,227 adult hospitalizations was examined between October 2017 and December 2019 during a hospital-wide substance use screening program with manual screening. Manually completed Drug Abuse Screening Test served as the reference standard to validate a convolutional neural network (CNN) classifier with coded word embedding features from the clinical notes of the EHR. The opioid classifier utilized all notes in the EHR and sensitivity analysis was also performed on the first 24 h of notes. Calibration was performed to account for the lower prevalence than in the original cohort. RESULTS Manual screening for substance misuse was completed in 67.8% (n = 56,227) with 1.1% (n = 628) identified with opioid misuse. The data for external validation included 2,482,900 notes with 67,969 unique clinical concept features. The opioid classifier had an AUC of 0.99 (95% CI 0.99-0.99) across the encounter and 0.98 (95% CI 0.98-0.99) using only the first 24 h of notes. In the calibrated classifier, the sensitivity and positive predictive value were 0.81 (95% CI 0.77-0.84) and 0.72 (95% CI 0.68-0.75). For the first 24 h, they were 0.75 (95% CI 0.71-0.78) and 0.61 (95% CI 0.57-0.64). CONCLUSIONS Our opioid misuse classifier had good discrimination during external validation. Our model may provide a comprehensive and automated approach to opioid misuse identification that augments current workflows and overcomes manual screening barriers.
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Affiliation(s)
- Majid Afshar
- Division of Health Informatics and Data Science, Loyola University Chicago, Maywood, IL, USA.
- Department of Medicine, University of Wisconsin, 1685 Highland Avenue, Madison, WI, 53705, USA.
| | - Brihat Sharma
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sameer Bhalla
- Rush Medical College, Rush University, Chicago, IL, USA
| | - Hale M Thompson
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Dmitriy Dligach
- Department of Computer Science, Loyola University Chicago, Chicago, IL, USA
| | - Randy A Boley
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Ekta Kishen
- Clinical Research Analytics, Research Core, Rush University Medical Center, Chicago, IL, USA
| | - Alan Simmons
- Clinical Research Analytics, Research Core, Rush University Medical Center, Chicago, IL, USA
| | - Kathryn Perticone
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Niranjan S Karnik
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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Sharma B, Dligach D, Swope K, Salisbury-Afshar E, Karnik NS, Joyce C, Afshar M. Publicly available machine learning models for identifying opioid misuse from the clinical notes of hospitalized patients. BMC Med Inform Decis Mak 2020; 20:79. [PMID: 32349766 PMCID: PMC7191715 DOI: 10.1186/s12911-020-1099-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/22/2020] [Indexed: 12/15/2022] Open
Abstract
Background Automated de-identification methods for removing protected health information (PHI) from the source notes of the electronic health record (EHR) rely on building systems to recognize mentions of PHI in text, but they remain inadequate at ensuring perfect PHI removal. As an alternative to relying on de-identification systems, we propose the following solutions: (1) Mapping the corpus of documents to standardized medical vocabulary (concept unique identifier [CUI] codes mapped from the Unified Medical Language System) thus eliminating PHI as inputs to a machine learning model; and (2) training character-based machine learning models that obviate the need for a dictionary containing input words/n-grams. We aim to test the performance of models with and without PHI in a use-case for an opioid misuse classifier. Methods An observational cohort sampled from adult hospital inpatient encounters at a health system between 2007 and 2017. A case-control stratified sampling (n = 1000) was performed to build an annotated dataset for a reference standard of cases and non-cases of opioid misuse. Models for training and testing included CUI codes, character-based, and n-gram features. Models applied were machine learning with neural network and logistic regression as well as expert consensus with a rule-based model for opioid misuse. The area under the receiver operating characteristic curves (AUROC) were compared between models for discrimination. The Hosmer-Lemeshow test and visual plots measured model fit and calibration. Results Machine learning models with CUI codes performed similarly to n-gram models with PHI. The top performing models with AUROCs > 0.90 included CUI codes as inputs to a convolutional neural network, max pooling network, and logistic regression model. The top calibrated models with the best model fit were the CUI-based convolutional neural network and max pooling network. The top weighted CUI codes in logistic regression has the related terms ‘Heroin’ and ‘Victim of abuse’. Conclusions We demonstrate good test characteristics for an opioid misuse computable phenotype that is void of any PHI and performs similarly to models that use PHI. Herein we share a PHI-free, trained opioid misuse classifier for other researchers and health systems to use and benchmark to overcome privacy and security concerns.
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Affiliation(s)
- Brihat Sharma
- Department of Computer Science, Loyola University Chicago, Chicago, IL, USA
| | - Dmitriy Dligach
- Department of Computer Science, Loyola University Chicago, Chicago, IL, USA.,Center for Health Outcomes and Informatics Research, Loyola University Chicago, 2160 S. First Avenue, Maywood, IL, 60156, USA
| | - Kristin Swope
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Elizabeth Salisbury-Afshar
- Center for Multi-System Solutions to the Opioid Epidemic, American Institute for Research, Chicago, IL, USA
| | - Niranjan S Karnik
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA
| | - Cara Joyce
- Center for Health Outcomes and Informatics Research, Loyola University Chicago, 2160 S. First Avenue, Maywood, IL, 60156, USA.,Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Majid Afshar
- Center for Health Outcomes and Informatics Research, Loyola University Chicago, 2160 S. First Avenue, Maywood, IL, 60156, USA. .,Department of Health Informatics and Data Science, Loyola University Chicago, Maywood, IL, USA. .,Department of Medicine, Loyola University Medical Center, Maywood, IL, USA.
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Cochran BN, Flentje A, Heck NC, Van Den Bos J, Perlman D, Torres J, Valuck R, Carter J. Factors predicting development of opioid use disorders among individuals who receive an initial opioid prescription: mathematical modeling using a database of commercially-insured individuals. Drug Alcohol Depend 2014; 138:202-8. [PMID: 24679839 PMCID: PMC4046908 DOI: 10.1016/j.drugalcdep.2014.02.701] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 02/21/2014] [Accepted: 02/23/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prescription drug abuse in the United States and elsewhere in the world is increasing at an alarming rate with non-medical opioid use, in particular, increasing to epidemic proportions over the past two decades. It is imperative to identify individuals most likely to develop opioid abuse or dependence to inform large-scale, targeted prevention efforts. METHODS The present investigation utilized a large commercial insurance claims database to identify demographic, mental health, physical health, and healthcare service utilization variables that differentiate persons who receive an opioid abuse or dependence diagnosis within two years of filling an opioid prescription (OUDs) from those who do not receive such a diagnosis within the same time frame (non-OUDs). RESULTS When compared to non-OUDs, OUDs were more likely to: (1) be male (59.9% vs. 44.2% for non-OUDs) and younger (M=37.9 vs. 47.7); (2) have a prescription history of more opioids (1.7 vs. 1.2), and more days supply of opioids (M=272.5, vs. M=33.2; (3) have prescriptions filled at more pharmacies (M=3.3 per year vs. M=1.3); (4) have greater rates of psychiatric disorders; (5) utilize more medical and psychiatric services; and (6) be prescribed more concomitant medications. A predictive model incorporating these findings was 79.5% concordant with actual OUDs in the data set. CONCLUSIONS Understanding correlates of OUD development can help to predict risk and inform prevention efforts.
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Affiliation(s)
- Bryan N Cochran
- Department of Psychology, Skaggs Building Room 143, The University of Montana, Missoula, MT 59812, United States.
| | - Annesa Flentje
- University of California, San Francisco, San Francisco General Hospital, 1001 Potrero Avenue, Suite 7 M, San Francisco, CA 94110, United States
| | - Nicholas C Heck
- Department of Psychology, Skaggs Building Room 143, The University of Montana, Missoula, MT 59812, United States
| | - Jill Van Den Bos
- Milliman, Inc., 1400 Wewatta St, Suite 300, Denver, CO 80202, United States
| | - Dan Perlman
- Milliman, Inc., 1400 Wewatta St, Suite 300, Denver, CO 80202, United States
| | - Jorge Torres
- Milliman, Inc., 1400 Wewatta St, Suite 300, Denver, CO 80202, United States
| | - Robert Valuck
- University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Mail Stop C238, 12850 E. Montview Blvd. V20-1201, Aurora, CO 80045, United States
| | - Jean Carter
- Department of Pharmacy Practice, 32 Campus Drive, The University of Montana, Missoula, MT 59812, United States
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Smith SM, Dart RC, Katz NP, Paillard F, Adams EH, Comer SD, Degroot A, Edwards RR, Haddox JD, Jaffe JH, Jones CM, Kleber HD, Kopecky EA, Markman JD, Montoya ID, O’Brien C, Roland CL, Stanton M, Strain EC, Vorsanger G, Wasan AD, Weiss RD, Turk DC, Dworkin RH. Classification and definition of misuse, abuse, and related events in clinical trials: ACTTION systematic review and recommendations. Pain 2013; 154:2287-2296. [PMID: 23792283 PMCID: PMC5460151 DOI: 10.1016/j.pain.2013.05.053] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 04/29/2013] [Accepted: 05/17/2013] [Indexed: 11/25/2022]
Abstract
As the nontherapeutic use of prescription medications escalates, serious associated consequences have also increased. This makes it essential to estimate misuse, abuse, and related events (MAREs) in the development and postmarketing adverse event surveillance and monitoring of prescription drugs accurately. However, classifications and definitions to describe prescription drug MAREs differ depending on the purpose of the classification system, may apply to single events or ongoing patterns of inappropriate use, and are not standardized or systematically employed, thereby complicating the ability to assess MARE occurrence adequately. In a systematic review of existing prescription drug MARE terminology and definitions from consensus efforts, review articles, and major institutions and agencies, MARE terms were often defined inconsistently or idiosyncratically, or had definitions that overlapped with other MARE terms. The Analgesic, Anesthetic, and Addiction Clinical Trials, Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership convened an expert panel to develop mutually exclusive and exhaustive consensus classifications and definitions of MAREs occurring in clinical trials of analgesic medications to increase accuracy and consistency in characterizing their occurrence and prevalence in clinical trials. The proposed ACTTION classifications and definitions are designed as a first step in a system to adjudicate MAREs that occur in analgesic clinical trials and postmarketing adverse event surveillance and monitoring, which can be used in conjunction with other methods of assessing a treatment's abuse potential.
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Affiliation(s)
- Shannon M. Smith
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Richard C. Dart
- University of Colorado School of Medicine and Rocky Mountain Poison & Drug Center, Denver Health, Denver, CO
| | - Nathaniel P. Katz
- Analgesic Solutions, Natick, MA, and Tufts University, Boston, MA, USA
| | | | | | - Sandra D. Comer
- Columbia University; New York State Psychiatric Institute, New York, NY, USA
| | | | | | - J. David Haddox
- Purdue Pharma L.P., Stamford, CT, and Tufts University, Boston, MA, USA
| | - Jerome H. Jaffe
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Herbert D. Kleber
- Columbia University; New York State Psychiatric Institute, New York, NY, USA
| | | | - John D. Markman
- Department of Neurosurgery, University of Rochester, Rochester, NY, USA
| | | | | | | | | | - Eric C. Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Roger D. Weiss
- Harvard Medical School, Boston, MA, USA and Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA, USA
| | - Dennis C. Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Robert H. Dworkin
- Departments of Anesthesiology and Neurology and Center for Human Experimental Therapeutics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Grattan A, Sullivan MD, Saunders KW, Campbell CI, Von Korff MR. Depression and prescription opioid misuse among chronic opioid therapy recipients with no history of substance abuse. Ann Fam Med 2012; 10:304-11. [PMID: 22778118 PMCID: PMC3392289 DOI: 10.1370/afm.1371] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Opioid misuse in the context of chronic opioid therapy (COT) is a growing concern. Depression may be a risk factor for opioid misuse, but it has been difficult to tease out the contribution of co-occurring substance abuse. This study aims to examine whether there is an association between depression and opioid misuse in patients receiving COT who have no history of substance abuse. METHODS A telephone survey was conducted at Group Health Cooperative and Kaiser Permanente of Northern California. We interviewed 1,334 patients on COT for noncancer pain who had no history of substance abuse. Patients were asked about 3 forms of opioid misuse: (1) self-medicating for symptoms other than pain, (2) self-increasing doses, and (3) giving to or getting opioids from others. Depression was evaluated by the 8-item Patient Health Questionnaire (PHQ-8). RESULTS Compared with patients who were not depressed (PHQ-8 score 0 to 4), patients with moderate depression (PHQ-8 score 10 to 14) and severe depression (PHQ-8 score 15 or higher) were 1.8 and 2.4 times more likely, respectively, to misuse their opioid medications for non-pain symptoms. Patients with mild (PHQ-8 score 5 to 9), moderate, and severe depression were 1.9, 2.9, and 3.1 times more likely, respectively, to misuse their opioid medications by self-increasing their dose. There was no statistically significant association between depression and giving opioids to or getting them from others. CONCLUSION In patients with no substance abuse history, depressive symptoms are associated with increased rates of some forms of self-reported opioid misuse. Clinicians should be alert to the risk of patients with depressive symptoms using opioids to relieve these symptoms and thereby using more opioids than prescribed.
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Affiliation(s)
- Alicia Grattan
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195-6560, USA
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