Abuse & Misuse Risk Assessment Tools from FDA – for Opioids, Ketamine, Adderall, Xanax, Ativan, Valium, Any Drugs of Abuse


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Risk Assessment Tools Examples from FDA.gov

page 11  (pdf)

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We must always remember, all of us, families, friends and physicians alike, the possibility of opioid use disorder (OUD) in anyone on chronic opioid therapy (COT) and those who are prescribed any drugs of abuse such as Ketamine, Adderall and benzodiazepines such as Valium, Ativan, Xanax. None of us should be taking medications that interfere with our ability to think and function. None of us should be taking more than we need. Many of us do not realize that less is more.

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Details of many tools for risk assessment are reviewed previously here.

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Keep this in mind:

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  • “Assessing risk of abuse and OUD in patients receiving COT is a dynamic, ongoing process.

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  •  Diagnosing misuse, abuse and OUD in patients with pain is complex

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  • Current screening tools do not diagnose abuse or OUD but only misuse and not intent”

     

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Tools

# of Items

 Administered

Patients considered for long-term opioid therapy:

ORT Opioid Risk Tool

5

By patient

SOAPP® Screener & Opioid Assessment for Patients w/ Pain

24, 14, & 5

By patient

DIRE Diagnosis, Intractability, Risk, & Efficacy Score

7

By clinician

Characterize misuse once opioid treatments begins:

PMQ Pain Medication Questionnaire

26

By patient

COMM Current Opioid Misuse Measure

17

By patient

PDUQ Prescription Drug Use Questionnaire

40

By clinician

Not specific to pain populations:

CAGE-AID Cut Down, Annoyed, Guilty, Eye-Opener Tool, Adjusted to Include Drugs

4

By clinician

RAFFT Relax, Alone, Friends, Family, Trouble

5

By patient

DAST Drug Abuse Screening Test

28

By patient

SBIRT Screening, Brief Intervention, & Referral to Treatment

Varies

By clinician

 

Risk Assessment Tools for Addiction


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“Anyone can become addicted to drugs.”

National Institute on Drug Abuse (NIDA)

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Addiction is a life-threatening and progressive disease that is multidimensional, often hereditary, characterized by three things: craving, compulsive use, and use despite harm.

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Monitoring Misuse, Diversion, Abuse

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Monitoring may depend on assessment of risk and may include:

1. Urine drug testing (UDT)

2. Prescription Drug Monitoring Programs (PDMPs) that are state-run programs for federally controlled substance, the CURES program in California.

3.  Medication monitoring. Accounting for remaining doses of prescribed medication – pill or device counts, and counts of used units when applicable

4. Validated short instruments are often more practical in a clinical setting, e.g. ORT, COMM***, CAGE-AID, SOAPP.

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Screening tools

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Screening tools are not lie detector tests.

It is helpful to meet with family or friends.

It may be the addict who finds reasons that this is not possible.

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The American Academy of Pain Medicine has a set of tools on one page from various sources including information on drug metabolism.

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Opioid Risk Tool (ORT)

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This tool, created by Lynn Webster, MD, includes history of preadolescent sexual abuse and history of psychological disease including ADD. Predictive validity. To assess risk of prescription opioid misuse in a patient being considered for opioid therapy.

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COMM

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Identify aberrant behaviors associated with misuse of opioid medications in a patient currently on opioid therapy.
“Includes questions developed using input from a panel of experts and concept mapping® analyses.
Scale designed to over-identify misuse rather than fail to identify patients who are actually abusing their medication.
May be useful for providers who need to document patients’ compliance with opioids.
May reduce physicians’ concerns related to prescribing opioids.
May keep patients more cognizant of their need to be responsible with opioids.”

A score of 9 or above is a positive indicator, ie, patient has been identified as misusing his/her medication and is at an increased risk of abuse, and the patient may require additional precautions and/or monitoring if treated with long-term opioid therapy.

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CAGE-AID QUESTIONNAIRE (pdf)

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The is the familiar CAGE questionnaire for alcohol, now adapted to include drugs.

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DAST-10 (pdf)

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“The Drug Abuse Screening Test (DAST-10) is a 10-item brief screening tool that can be administered by a clinician or self-administered. Each question requires a yes or no response, and the tool can be completed in less than 8 minutes. This tool assesses drug use, not including alcohol or tobacco use, in the past 12 months.”

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NIDA Quick Screen Question (pdf)

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Includes alcohol, tobacco, all drugs including steroids, over lifetime use, the past year use, and recent use. Scoring stratifies by level of risk with treatment recommendations. If IV use, it recommends testing HIV and Hepatitis B/C.

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Other tools and resources at NIDA

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Please see their website. Drug abuse is a vast field. A busy site, difficult to find tools for screening.

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Clinical Resources: Prescription Opioids

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DrugAbuse.gov is a busy site with many useful resources.

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Screening Drug Use in a General Medical Setting (pdf)

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 An excellent tool guides all the way through to treatment. “Advise, Assess, Assist and Arrange.”

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Screener and Opioid Assessment for Patients with Pain SOAPP (pdf)

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This self-administered questionnaire takes just minutes to complete and score.  Clinicians can use the results to:

  • Better predict a patient’s likelihood of misusing or abusing opioids.

  • Document decisions about a recommended level of monitoring for a patient.

  • Justify referrals to specialty pain clinics.

    • Available to clinicians at PainEDU.org® (questionnaire, background information and scoring instructions may be downloaded at no charge).

    • Comes in four versions: 5, 14, 24 questions and the Revised SOAPP: SOAPP-R.

    • May be self-administered at or prior to an office visit, or completed as part of an interview with a nurse, physician or psychologist.

    • May help differentiate those patients who require more or less clinician monitoring while on long-term opioid therapy.

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This applies to addiction as much as to pain:.

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“We must begin to (explore) the meanings of pain in order that we do not reduce human suffering to the dimensions of a mere physical problem for which, if we could only find the right pill, there is always a medical solution….medicine alone cannot possibly resolve all the questions raised by pain.”

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David Morris, The Culture of Pain, UC Press 1991

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