HCPLive Network

Physicians Often Underestimate the Risk of Opioid Abuse, Misuse, and Diversion in Chronic Pain Patients


Despite rampant opioid misuse, abuse, and diversion self-reported by chronic pain patients in a study presented at the American Pain Society 33rd Annual Scientific Meeting, held April 30, 2014, to May 3, 2014, in Tampa, FL, primary care providers tended to downgrade the patients’ risk for engaging in those drug-related aberrant behaviors, indicating a gap between physicians’ objective risk assessment for opioid abuse and the actual extent of the problem.
 
Using data from the ACCESS and ConVERT studies conducted in chronic pain patients receiving Avinza (extended-release morphine sulfate) or Embeda (extended-release morphine sulfate/naltrexone hydrochloride), respectively, Beatrice Setnik, PhD; and Carl L. Roland, PharmD, MS; and Glenn C. Pixton, MS, of Pfizer, Inc., alongside Kenneth W. Sommerville, MD, of the Duke University Medical Center in Durham, NC, “compare(d) investigator assessment of patient risk for behaviors related to prescription opioid misuse, abuse, and diversion with patient self-reports with patient self-reports of these activities and with the objective urine drug testing.”
 
Although both of the studies utilized patient medical history, urine drug test results, and physician ratings of the patients’ risk levels for aberrant behaviors related to opioids, each implemented different risk assessment questionnaires.
 
For instance, the investigators in the ACCESS study utilized several tools to determine their patients’ risk for opioid misuse and abuse, including “treatment agreement, card for obtaining/tracking prescriptions, (the) Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R), (and) pill count,” whereas those participating in the ConVERT study completed the Investigator Risk Assessment Questionnaire (IRAQ) at the first visit in order to evaluate the perceived risk of opioid misuse, abuse, and diversion in a given patient and document the sources used to make the risk assessment, the poster authors observed.
 
On the self-assessment side, patients in the ACCESS study also completed the 24-item SOAPP-R, while those in the ConVERT study filled out the 17-item Current Opioid Misuse Measure (COMM) and the Self-Reported Misuse, Abuse, and Diversion (SR-MAD) questionnaire.
 
According to Setnik and her co-authors, the investigators in the ACCESS study designated 46.9% of the patients as low risk for aberrant behaviors, 51.8% as moderate, and a mere 1.3% as high risk. Similarly, in the ConVERT study, the investigators labeled the vast majority of the patients as low risk for abuse (89.3%), misuse (84.2%), and diversion (94.3%) — assessments they based “mostly on medical history (84.9%), patient interview (81.7%), and history of treating/knowing the patient (67.8%) … (while) only 21.5% of investigators used questionnaires to assess risk.” Less than 2% of patients were considered high risk for each of those behaviors by the investigators in the ConVERT study.
 
Yet, 24.8% of the patients who completed the SOAPP-R indicated high risk of opioid abuse, misuse, and diversion; 40.6% of COMM responders were categorized as engaging in the drug-related aberrant behaviors; and an astounding 60% of those who filled out the SR-MAD questionnaire admitted using more opioids than prescribed (Figure 1).
 


In response to those findings, the poster authors suggested that “physicians may require additional education and/or training on the appropriate interpretation and identification of signals resulting from risk assessment tools.”
 
However, Roland pointed out during the poster presentation that “the way this was set up was under a certificate of confidentially, so the patients were told their physicians would not see the results.” Thus, he said “it would be difficult for physicians to implement these methods in clinical settings.”
Further Reading
The US Food and Drug Administration (FDA) announced it will give priority review status to Amgen’s application to market ivabradine as a treatment for chronic heart failure. The drug works to slow the heart rate in appropriate patients without causing negative effects on cardiac rhythms. It was developed by Les Laboratoires Servier in Suresnes, France, and first approved by the European Medicines Agency (EMA) as Procoralan in 2005. According to Servier, a global pharmaceutical firm, Procoralan (also sold as Corlentor) is available in 102 countries.
As healthcare organizations look to cut costs while increasing patient safety and satisfaction, the focus is all landing on how to make the employee happy.
As the nation tries to cut its health-care costs critics of reform have worried that some patients who need expensive though risky procedures like coronary artery bypass graft surgery (CABG) might not get them. But a new Harvard School of Public Health study could allay those fears.
With more people than ever using cell phones, tablets, and other personal technological devices, dermatologists have voiced concerns over the increase in cases of nickel allergies. Nickel, one of the most prevalent allergens in the United States, can be found within most handheld electronic devices and jewelry.
Although hemodialysis is a commonly used treatment for kidney failure, a recent study has shown it may not be as beneficial for people who develop a sudden case of the condition.
Healthcare workers in poor nations often do not have enough protective gear to keep them safe from being infected with blood-borne viruses such as Ebola and HIV, according to a study published online Aug. 8 in Tropical Medicine & International Health.
Para-aortic radiation correlates with increased diabetes mellitus risk for Hodgkin's lymphoma survivors, according to a study published online Aug. 25 in the Journal of Clinical Oncology.
More Reading
The US Food and Drug Administration (FDA) announced it will give priority review status to Amgen’s application to market ivabradine as a treatment for chronic heart failure. The drug works to slow the heart rate in appropriate patients without causing negative effects on cardiac rhythms. It was developed by Les Laboratoires Servier in Suresnes, France, and first approved by the European Medicines Agency (EMA) as Procoralan in 2005. According to Servier, a global pharmaceutical firm, Procoralan (also sold as Corlentor) is available in 102 countries.