This tool showed nearly 90% predictive accuracy in a Veterans Administration case control analysis of close to 9,000 veteran patients 125 and was subsequently Screening for opioid misuse risk Several screening tools are available to help HCPs detect current opioid misuse or the risk that a patient may develop misuse or OUD during the course of opioid therapy. None has been associated with a high degree of predictive accuracy; 3,64 however, they are generally recommended in expert guidelines for their clinical utility (Table 6). Most of the tools in Table 6 are specific to opioid-treated patients with pain. The HHS Inter-Agency Task Force has also cited the Drug Abuse Screening Test 127 and the Alcohol Use Disorders Identification Test 128 as validated tools. 3 HCPs should select the tool that fits best into their clinical practice, treating assessment as routine and encouraging patients to share information honestly. Even single questions, such as, “How many times in
validated in the commercial insurance records of a nonveteran population of approximately 18 million medical users of prescription opioids. 126
the past year have you used an illegal drug or used a prescription medication for nonmedical reasons?” can be effective means of screening for drug use if implemented consistently. 129 An answer to the single question of one or more is considered positive and was found in a primary care setting to be 100% sensitive and 73.5% specific for the detection of a drug-use disorder compared with a standardized diagnostic interview. 61,129 The information gained from screening is documented in the patient record and used to assist selection of the best treatments, including medication classes and delivery systems, to facilitate ongoing monitoring to help mitigate potential opioid misuse, and to inform whether SUD treatment and mental-health referrals are warranted.
Table 6: Screening Tools for Risk of OUD in Opioid-Treated Patients Tool # of
Approximate Time to Complete
Items Administered
For Use Prior to Initiating Opioid Therapy Opioid Risk Tool (ORT) 129
5 Healthcare practitioner
1 min 5 min
Revised Screener and Opioid Assessment for Patients with Pain (SOAPP-R) 130
24* Patient
Diagnosis, Intractability, Risk, Efficacy (DIRE) 131
7 Healthcare practitioner
2 min
Pain Medication Questionnaire (PMQ) 132
26 Patient
10 min
For Use During Opioid Therapy Current Opioid Misuse Measure (COMM) 133
17 Patient
10 min
Patient Version Prescription Drug Use Questionnaire (PDUQp) 134
31 Patient
20 min
Brief Initial Drug Screenings Not Specific to Pain Population CAGE-AID (Adapted to Include Drugs) 135
4 Healthcare practitioner
1 min
Drug Abuse Screening Test (DAST) 127
10 Healthcare practitioner or patient versions 10 Healthcare practitioner or patient versions
5 min
Alcohol Use Disorders Identification Test 128
5 min
*4- and 12-item SOAPP formats available
A baseline urine drug test (UDT) should take place before opioids are prescribed or continued. 23,64,78 Usefulness of a UDT includes identifying the presence of prescribed medications as well as unauthorized prescription and illegal drugs, helping to guide clinical decisions, and serving as an alert to potential
drug-drug interactions. Immunoassay testing done at the point of care (POC) can help quickly establish whether a new patient has recently ingested illegal drugs or other opioid and prescription drugs but typically cannot isolate specific opioids. 130 If POC test results are inconsistent with medical direction,
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Book Code: MDCO1025
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