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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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Finkelman MD, Wei T, Lowe SR. Computer-Based Testing to Shorten the Social Communication Questionnaire (SCQ): a Proof- of-Principle Study of the Lifetime and Current Forms. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021. [DOI: 10.1007/s10862-020-09853-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Weiner SG, Hoppe JA, Finkelman MD. Techniques to Shorten a Screening Tool for Emergency Department Patients. West J Emerg Med 2019; 20:804-809. [PMID: 31539338 PMCID: PMC6754189 DOI: 10.5811/westjem.2019.7.42938] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 07/09/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction Screening of patients for opioid risk has been recommended prior to opioid prescribing. Opioids are prescribed frequently in the emergency department (ED) setting, but screening tools are often of significant length and therefore limited in their utility. We describe and evaluate three approaches to shortening a screening tool: creation of a short form; curtailment; and stochastic curtailment. Methods To demonstrate the various shortening techniques, this retrospective study used data from two studies of ED patients for whom the provider was considering providing an opioid prescription and who completed the Screener and Opioid Assessment for Patients with Pain-Revised, a 24-item assessment. High-risk criteria from patients’ prescription drug monitoring program data were used as an endpoint. Using real-data simulation, we determined the sensitivity, specificity, and test length of each shortening technique. Results We included data from 188 ED patients. The original screener had a test length of 24 questions, a sensitivity of 44% and a specificity of 76%. The 12-question short form had a sensitivity of 41% and specificity of 75%. Curtailment and stochastic curtailment reduced the question length (mean test length ranging from 8.1–19.7 questions) with no reduction in sensitivity or specificity. Conclusion In an ED population completing computer-based screening, the techniques of curtailment and stochastic curtailment markedly reduced the screening tool’s length but had no effect on test characteristics. These techniques can be applied to improve efficiency of screening patients in the busy ED environment without sacrificing sensitivity or specificity.
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Affiliation(s)
- Scott G Weiner
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Jason A Hoppe
- University of Colorado Denver School of Medicine, Department of Emergency Medicine, Aurora, Colorado
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Alzeer AH, Jones J, Bair MJ. Review of Factors, Methods, and Outcome Definition in Designing Opioid Abuse Predictive Models. PAIN MEDICINE 2019; 19:997-1009. [PMID: 29016966 DOI: 10.1093/pm/pnx149] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective Several opioid risk assessment tools are available to prescribers to evaluate opioid analgesic abuse among chronic patients. The objectives of this study are to 1) identify variables available in the literature to predict opioid abuse; 2) explore and compare methods (population, database, and analysis) used to develop statistical models that predict opioid abuse; and 3) understand how outcomes were defined in each statistical model predicting opioid abuse. Design The OVID database was searched for this study. The search was limited to articles written in English and published from January 1990 to April 2016. This search generated 1,409 articles. Only seven studies and nine models met our inclusion-exclusion criteria. Results We found nine models and identified 75 distinct variables. Three studies used administrative claims data, and four studies used electronic health record data. The majority, four out of seven articles (six out of nine models), were primarily dependent on the presence or absence of opioid abuse or dependence (ICD-9 diagnosis code) to define opioid abuse. However, two articles used a predefined list of opioid-related aberrant behaviors. Conclusions We identified variables used to predict opioid abuse from electronic health records and administrative data. Medication variables are the recurrent variables in the articles reviewed (33 variables). Age and gender are the most consistent demographic variables in predicting opioid abuse. Overall, there is similarity in the sampling method and inclusion/exclusion criteria (age, number of prescriptions, follow-up period, and data analysis methods). Intuitive research to utilize unstructured data may increase opioid abuse models' accuracy.
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Affiliation(s)
- Abdullah H Alzeer
- Indiana University School of Informatics and Computing, Indianapolis, Indiana
| | - Josette Jones
- Indiana University School of Informatics and Computing, Indianapolis, Indiana.,Regenstrief Institute, Indianapolis, Indiana.,Indiana University School of Nursing, Indianapolis, Indiana
| | - Matthew J Bair
- Regenstrief Institute, Indianapolis, Indiana.,Richard L. Roudebush VA Medical Center, Center for Health Information and Communication (CHIC), Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana, USA
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McCaffrey SA, Black RA, Villapiano AJ, Jamison RN, Butler SF. Development of a Brief Version of the Current Opioid Misuse Measure (COMM): The COMM-9. PAIN MEDICINE 2017; 20:113-118. [DOI: 10.1093/pm/pnx311] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Ryan A Black
- Inflexxion Inc., Waltham, Massachusetts
- Nova Southeastern University, College of Psychology, Fort Lauderdale, Florida
| | | | - Robert N Jamison
- Anesthesia and Psychiatry, Brigham and Women’s Hospital Harvard Medical Center, Pain Management Center, Chestnut Hill, Massachusetts, USA
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Kulich RJ, Backstrom J, Brownstein J, Finkelman M, Dhadwal S, DiBennedetto D. A Model for Opioid Risk Stratification: Assessing the Psychosocial Components of Orofacial Pain. Oral Maxillofac Surg Clin North Am 2017; 28:261-73. [PMID: 27475506 DOI: 10.1016/j.coms.2016.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article describes a model of opiate risk stratification with a special focus on dentistry and oral surgery. A brief overview covers the scope of the US opioid abuse and misuse epidemic, and the role of the dentist in mitigating the problems of diversion and misuse of controlled substances. The expanding role of dentistry is summarized. An assessment outlines gathering critical risk information, screening questionnaires, access to state prescription monitoring programs, and communication with cotreating providers. Special populations are discussed. Barriers and possible solutions for effective implementation of these strategies are summarized.
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Affiliation(s)
- Ronald J Kulich
- Department of Diagnostic Sciences, Craniofacial Pain and Headache Center, Tufts School of Dental Medicine, Boston, MA, USA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | | | - Jennifer Brownstein
- Department of Diagnostic Sciences, Craniofacial Pain and Headache Center, Tufts School of Dental Medicine, Boston, MA, USA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew Finkelman
- Department of Biostatistics and Experimental Design, Tufts University School of Dental Medicine, 1 Kneeland Street, 7th Floor, Boston, MA 02129, USA
| | - Shuchi Dhadwal
- Department of Diagnostic Sciences, Craniofacial Pain and Headache Center, Tufts School of Dental Medicine, Boston, MA, USA
| | - David DiBennedetto
- Department of Diagnostic Sciences, Boston Pain Care, Tufts School of Dental Medicine, Boston, MA, USA
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Pouget ER, Bennett AS, Elliott L, Wolfson-Stofko B, Almeñana R, Britton PC, Rosenblum A. Development of an opioid-related Overdose Risk Behavior Scale (ORBS). Subst Abus 2017; 38:239-244. [PMID: 28113004 PMCID: PMC5522769 DOI: 10.1080/08897077.2017.1282914] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Drug overdose has emerged as the leading cause of injury-related death in the United States, driven by prescription opioid (PO) misuse, polysubstance use, and use of heroin. To better understand opioid-related overdose risks that may change over time and across populations, there is a need for a more comprehensive assessment of related risk behaviors. Drawing on existing research, formative interviews, and discussions with community and scientific advisors an opioid-related Overdose Risk Behavior Scale (ORBS) was developed. METHODS Military veterans reporting any use of heroin or POs in the past month were enrolled using venue-based and chain referral recruitment. The final scale consisted of 25 items grouped into 5 subscales eliciting the number of days in the past 30 during which the participant engaged in each behavior. Internal reliability, test-retest reliability and criterion validity were assessed using Cronbach's alpha, intraclass correlations (ICC) and Pearson's correlations with indicators of having overdosed during the past 30 days, respectivelyInternal reliability, test-retest reliability and criterion validity were assessed using Cronbach's alpha, intraclass correlations (ICC) and Pearson's correlations with indicators of having overdosed during the past 30 days, respectively. RESULTS Data for 220 veterans were analyzed. The 5 subscales-(A) Adherence to Opioid Dosage and Therapeutic Purposes; (B) Alternative Methods of Opioid Administration; (C) Solitary Opioid Use; (D) Use of Nonprescribed Overdose-associated Drugs; and (E) Concurrent Use of POs, Other Psychoactive Drugs and Alcohol-generally showed good internal reliability (alpha range = 0.61 to 0.88), test-retest reliability (ICC range = 0.81 to 0.90), and criterion validity (r range = 0.22 to 0.66). The subscales were internally consistent with each other (alpha = 0.84). The scale mean had an ICC value of 0.99, and correlations with validators ranged from 0.44 to 0.56. CONCLUSIONS These results constitute preliminary evidence for the reliability and validity of the new scale. If further validated, it could help improve overdose prevention and response research and could help improve the precision of overdose education and prevention efforts.
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Affiliation(s)
- Enrique R. Pouget
- National Development and Research Institutes, Inc., New York, New York, USA
| | - Alex S. Bennett
- National Development and Research Institutes, Inc., New York, New York, USA
| | - Luther Elliott
- National Development and Research Institutes, Inc., New York, New York, USA
| | | | - Ramona Almeñana
- National Development and Research Institutes, Inc., New York, New York, USA
| | - Peter C. Britton
- Canandaigua VA Medical Center, Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Andrew Rosenblum
- National Development and Research Institutes, Inc., New York, New York, USA
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Smits N, Finkelman MD, Kelderman H. Stochastic Curtailment of Questionnaires for Three-Level Classification: Shortening the CES-D for Assessing Low, Moderate, and High Risk of Depression. APPLIED PSYCHOLOGICAL MEASUREMENT 2016; 40:22-36. [PMID: 29881034 PMCID: PMC5978527 DOI: 10.1177/0146621615592294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In clinical assessment, efficient screeners are needed to ensure low respondent burden. In this article, Stochastic Curtailment (SC), a method for efficient computerized testing for classification into two classes for observable outcomes, was extended to three classes. In a post hoc simulation study using the item scores on the Center for Epidemiologic Studies-Depression Scale (CES-D) of a large sample, three versions of SC, SC via Empirical Proportions (SC-EP), SC via Simple Ordinal Regression (SC-SOR), and SC via Multiple Ordinal Regression (SC-MOR) were compared at both respondent burden and classification accuracy. All methods were applied under the regular item order of the CES-D and under an ordering that was optimal in terms of the predictive power of the items. Under the regular item ordering, the three methods were equally accurate, but SC-SOR and SC-MOR needed less items. Under the optimal ordering, additional gains in efficiency were found, but SC-MOR suffered from capitalization on chance substantially. It was concluded that SC-SOR is an efficient and accurate method for clinical screening. Strengths and weaknesses of the methods are discussed.
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Affiliation(s)
- Niels Smits
- VU University Amsterdam, Amsterdam, The
Netherlands
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Zhao Y, Li Y, Zhang X, Lou F. Translation and validation of the Chinese version of the Current Opioid Misuse Measure (COMM) for patients with chronic pain in Mainland China. Health Qual Life Outcomes 2015; 13:147. [PMID: 26374505 PMCID: PMC4572659 DOI: 10.1186/s12955-015-0329-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 08/23/2015] [Indexed: 01/20/2023] Open
Abstract
Background Management of prescription opioids misuse and abuse problems among chronic pain patients has been increasingly important worldwide and little literature concerning prescription opioids can be found in mainland China so far. Methods The Current Opioid Misuse Measure (COMM) was translated into Chinese following Brislin’s model of cross-culture translation and was completed by a convenience sample of 180 patients with chronic pain recruited from two major hospitals in Jinan, Shandong province. Data were analyzed using internal consistency, test-retest reliability, exploratory factor analysis and confirmatory factor analysis. Results The internal consistency coefficient for the total score of the COMM was 0.85 and item-total correlations of all items were above 0.20. Besides, the test-retest reliability was satisfactory with an ICC of 0.91 (95 % CI = 0.65-0.98). Four principal components were extracted, accounting for 65.30 % of the variance, and the factor loadings of all 17 items were above 0.40. Conclusions The Chinese version of COMM showed satisfactory reliability and validity, and could be used as a screening tool to evaluate and monitor current aberrant drug-related behavior among Chinese patients with chronic pain.
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Affiliation(s)
- Yang Zhao
- School of Nursing, Shandong University, No.44, Wenhuaxi Road, Jinan, Shandong Province, 250012, People's Republic of China. .,Nursing Faculty, Tianjin Medical College, No. 14 Liulin Road, Tianjin, 300222, People's Republic of China.
| | - Yuli Li
- School of Nursing, Shandong University, No.44, Wenhuaxi Road, Jinan, Shandong Province, 250012, People's Republic of China.
| | - Xuekun Zhang
- School of Nursing, Shandong University, No.44, Wenhuaxi Road, Jinan, Shandong Province, 250012, People's Republic of China.
| | - Fenglan Lou
- School of Nursing, Shandong University, No.44, Wenhuaxi Road, Jinan, Shandong Province, 250012, People's Republic of China.
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Smits N, Finkelman MD. Shortening the PHQ-9: a proof-of-principle study of utilizing Stochastic Curtailment as a method for constructing ultrashort screening instruments. Gen Hosp Psychiatry 2015; 37:464-9. [PMID: 26026647 DOI: 10.1016/j.genhosppsych.2015.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 04/10/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE In primary care, screening instruments for mental health should be ultrashort to allow for routine usage. In this paper, Stochastic Curtailment is introduced as a method for constructing ultrashort screeners. METHOD In a post hoc diagnostic accuracy study using the item scores on the Patient Health Questionnaire depression module (PHQ-9) of a large sample (N=20, 685), Stochastic Curtailment was compared with two existing ultrashort versions of PHQ-9. The first was PHQ-2 (which includes the first two items of PHQ-9), and the second was a 'two-step' method (only if the PHQ-2 screened positive were all nine PHQ items administered). For PHQ-2 and two-step, both cut scores 2 and 3 were evaluated. RESULTS PHQ-2 showed the lowest and Stochastic Curtailment the highest diagnostic accuracy with reference to the classifications based on the full PHQ-9. To do so, Stochastic Curtailment used 3.08 items on average (S.D.=1.98), which was slightly less than two-step (M=3.18, S.D.=2.62) under its most accurate cut score (≥2). CONCLUSIONS It was concluded that Stochastic Curtailment is a promising method for constructing ultrashort screeners.
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Affiliation(s)
- Niels Smits
- Department of Clinical Psychology and Department of Methods, Faculty of Psychology and Education, VU University, Amsterdam, the Netherlands.
| | - Matthew D Finkelman
- Tufts Clinical and Translational Science Institute, Tufts University and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, USA
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Finkelman MD, Kulich RJ, Zacharoff KL, Smits N, Magnuson BE, Dong J, Butler SF. Shortening the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R): A Proof-of-Principle Study for Customized Computer-Based Testing. PAIN MEDICINE 2015; 16:2344-56. [PMID: 26176496 DOI: 10.1111/pme.12864] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) is a 24-item self-report instrument that was developed to aid providers in predicting aberrant medication-related behaviors among chronic pain patients. Although the SOAPP-R has garnered widespread use, certain patients may be dissuaded from taking it because of its length. Administrative barriers associated with lengthy questionnaires further limit its utility. OBJECTIVE To investigate the extent to which two techniques for computer-based administration (curtailment and stochastic curtailment) reduce the average test length of the SOAPP-R without unduly affecting sensitivity and specificity. DESIGN Retrospective study. SETTING Pain management centers. SUBJECTS Four hundred and twenty-eight chronic non-cancer pain patients. METHODS Subjects had taken the full-length SOAPP-R and been classified by the Aberrant Drug Behavior Index (ADBI) as having engaged or not engaged in aberrant medication-related behavior. Curtailment and stochastic curtailment were applied to the data in post-hoc simulation. Sensitivity and specificity with respect to the ADBI, as well as average test length, were computed for the full-length test, curtailment, and stochastic curtailment. RESULTS The full-length SOAPP-R exhibited a sensitivity of 0.745 and a specificity of 0.671 for predicting the ADBI. Curtailment reduced the average test length by 26% while exhibiting the same sensitivity and specificity as the full-length test. Stochastic curtailment reduced the average test length by as much as 65% while always exhibiting sensitivity and specificity for the ADBI within 0.035 of those of the full-length test. CONCLUSIONS Curtailment and stochastic curtailment have potential to improve the SOAPP-R's efficiency in computer-based administrations.
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Affiliation(s)
- Matthew D Finkelman
- Department of Public Health and Community Service, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Ronald J Kulich
- Craniofacial Pain and Headache Division, Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, Massachusetts, USA.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Niels Smits
- Department of Methods, Faculty of Psychology and Education, VU University, Amsterdam, The Netherlands
| | - Britta E Magnuson
- Department of Oral and Maxillofacial Pathology, Oral Medicine, and Craniofacial Pain, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Jinghui Dong
- Sackler School of Graduate Biomedical Sciences, Boston, Massachusetts, USA
| | - Stephen F Butler
- Inflexxion, Inc., Health Analytics Department, Newton, Massachusetts, USA
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Smith SM, Paillard F, McKeown A, Burke LB, Edwards RR, Katz NP, Papadopoulos EJ, Rappaport BA, Slagle A, Strain EC, Wasan AD, Turk DC, Dworkin RH. Instruments to Identify Prescription Medication Misuse, Abuse, and Related Events in Clinical Trials: An ACTTION Systematic Review. THE JOURNAL OF PAIN 2015; 16:389-411. [PMID: 25660826 DOI: 10.1016/j.jpain.2015.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 11/27/2022]
Abstract
UNLABELLED Measurement of inappropriate medication use events (eg, abuse or misuse) in clinical trials is important in characterizing a medication's abuse potential. However, no gold standard assessment of inappropriate use events in clinical trials has been identified. In this systematic review, we examine the measurement properties (ie, content validity, cross-sectional reliability and construct validity, longitudinal construct validity, ability to detect change, and responder definitions) of instruments assessing inappropriate use of opioid and nonopioid prescription medications to identify any that meet U.S. and European regulatory agencies' rigorous standards for outcome measures in clinical trials. Sixteen published instruments were identified, most of which were not designed for the selected concept of interest and context of use. For this reason, many instruments were found to lack adequate content validity (or documentation of content validity) to evaluate current inappropriate medication use events; for example, evaluating inappropriate use across the life span rather than current use, including items that did not directly assess inappropriate use (eg, questions about anger), or failing to capture information pertinent to inappropriate use events (eg, intention and route of administration). In addition, the psychometric data across all instruments were generally limited in scope. A further limitation is the heterogeneous, nonstandardized use of inappropriate medication use terminology. These observations suggest that available instruments are not well suited for assessing current inappropriate medication use within the specific context of clinical trials. Further effort is needed to develop reliable and valid instruments to measure current inappropriate medication use events in clinical trials. PERSPECTIVE This systematic review evaluates the measurement properties of inappropriate medication use (eg, abuse or misuse) instruments to determine whether any meet regulatory standards for clinical trial outcome measures to assess abuse potential.
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Affiliation(s)
- Shannon M Smith
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
| | | | - Andrew McKeown
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Robert R Edwards
- Department of Anesthesiology, Brigham & Women's Hospital, Boston, Massachusetts
| | - Nathaniel P Katz
- Department of Anesthesia, Tufts University, Boston, Massachusetts; Analgesic Solutions, Natick, Massachusetts
| | | | - Bob A Rappaport
- United States Food and Drug Administration, Silver Spring, Maryland
| | - Ashley Slagle
- United States Food and Drug Administration, Silver Spring, Maryland
| | - Eric C Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ajay D Wasan
- Departments of Anesthesiology and Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Robert H Dworkin
- Departments of Anesthesiology and Neurology, and Center for Human Experimental Therapeutics, University of Rochester School of Medicine and Dentistry, Rochester, New York
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