Opioid misuse in Canada and critical appraisal of aberrant behavior screening tools

Abstract

The incidence of prescription opioid misuse in Canada is increasing. Initiatives for safe prescribing practices for opioid medications include risk assessment for current and future opioid misuse. A clinical screening tool that can be universally applied to all patient populations is currently not available. Our objective was to provide a brief narrative review on opioid misuse from a Canadian perspective as well as a critical appraisal of the available clinical screening tools for detecting aberrant behaviors associated with opioid misuse. The Drug Abuse Screening Test, Addiction Behaviors Checklist, Diagnosis, Intractability, Risk and Efficacy Inventory, Pain Assessment and Documentation Tool, Prescription Drug Use Questionnaire, Prescription Opioid therapy Questionnaire, Screener and Opioid Assessment for Patients with Pain (SOAPP), Revised SOAPP, Pain Medication Questionnaire, Opioid Risk Tool and Current Opioid Misuse Measure were included in the following review. Overall, a wide variability in quality, sensitivity and specificity was observed between screening tools. There is an overall lack of applicability to diverse patient populations as the majority of screening tools have been validated in pain clinic populations only. To conclude, there is a great need for a validated and convenient aberrant behaviors risk assessment tool that can be applied to a diverse patient population in a clinical setting.

Keywords: Opioid analgesics, Opioid-related disorders, Prescription drug misuse, Risk assessment, Drug-seeking behavior, Canada

Core tip: With the increase in opioid prescribing in Canada, prescription opioid misuse is a growing concern from a health care, financial and safety standpoint. Definitions regarding opioid misuse and covariate risk factors predictive of opioid misuse are controversial. The currently available risk assessment tools used to predict or detect opioid misuse vary in terms of sensitivity, specificity, quality, reproducibility and have been validated in very limited patient populations. There is a clear need for the development of a generalizable risk assessment tool to assess for prescription opioid misuse.