Researchers have developed a brief and simple checklist that clinicians can use to monitor opioid adherence among people with chronic pain.
The 5-item Opioid Compliance Checklist (OCC) is completed by the patient and, used in conjunction with opioid therapy agreements, is designed to periodically monitor adherence alongside information from other sources, such as physical examination, clinical interview, regular urine toxicology testing and review of medical records.
“A patient’s responses to the 5-item OCC questions would be valuable in obtaining information that might not necessarily be obtained during follow-up appointments, especially by a non-specialist”, the researchers, led by Robert Jamison (Harvard Medical School, Boston, Massachusetts, USA) explain.
“Documentation of these responses might prove helpful in a medical/legal context as well, by providing a basis upon which to decide whether to request more frequent office visits, pill counts, urine toxicology screens, or discontinuation of therapy.”
The team identified five questions out of an initial 12 that correlated most strongly with the Drug Misuse Index in 157 patients taking long-term opioid medication for chronic noncancer pain. These were: “Lost or misplaced your opioid medications?”; “Run out of your pain medication early?”; “Missed any scheduled medical appointments?”; “Used any illegal or unauthorised substances?” and “Been completely honest about your personal drug use?”
The internal consistency of the 5-item OCC was relatively low, at 0.33. But Jamison and colleagues say this is not surprising given the low number of items and the heterogeneous nature of opioid compliance, which involves a wide range of behaviours that are not necessarily intercorrelated.
Multivariate logistic regression analysis showed that one positive response on the OCC predicted opioid misuse with a specificity of 71% and a sensitivity of 56%. The associated positive predictive value was 63% and the negative predictive value 67%.
Merits of the OCC include its brevity, taking just 1 minute to administer, the researchers comment, and the fact that it is easily understood by patients. It serves as a reminder to them to be careful when managing their medication, they note.
For the clinician, the OCC helps identify “those patients who may have greater difficulty modulating their own medical use of these drugs and therefore may require extra help in monitoring and management.”
The team adds that another possible benefit “is to help those clinicians who are uncomfortable prescribing opioids for pain management to realize that many patients are likely not to develop problems with these drugs.”
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