Opioid Abuse, Prescription Drug Abuse (Not Dependent)
Conditions
Brief summary
The goal of the study is to validate a Prescription Drug Monitoring Program-based opioid risk metric to discriminate between low, moderate, and high-risk opioid use disorder. The World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test (WHO ASSIST) will be used as the gold standard instrument that defines patient risk levels. No intervention or hypothesis will be tested.
Detailed description
Fatal overdose deaths involving prescription opioids, heroin, and synthetic opioids has continued to increase across the US-continuing to increase in 35 states from 2013-2017. Given these persistent trends for adverse opioid-related outcomes in populations across the US, it is critical to work to identify those who are at risk, deliver appropriate care that will help prevent progression to more severe opioid-related outcomes, and provide referral and treatment resources to those who suffer from opioid use disorder. Therefore, it is necessary to expand the continuum of care to health care settings that previously may have been underutilized. One underutilized resource for addressing the current opioid epidemic is community pharmacies.The most important clinical tool pharmacists have available to identify possible misuse of opioid medications is prescription drug monitoring programs (PDMP),which capture patient-level prescription dispensing information to inform monitoring, dispensing decisions, and possible intervention.These tools are available in all US states and have the potential to enable pharmacists to identify patients at-risk for opioid-related adverse events, such as addiction and overdose. In light of the continued escalation of the opioid epidemic nationally, combined with the promising opportunities afforded by the further inclusion of community pharmacy settings for engaging patients with opioid-related risk, it is important to evaluate whether current PDMP risk metrics correlate with clinically validated opioid risk tools and if clinically meaningful risk cutoffs exist for PDMP risk metrics. This study will evaluate the concurrent validity of a PDMP-based opioid risk metric as a clinical measure of high risk opioid use and establish clinically useful risk-level thresholds relative to the widely validated gold standard of the World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test (WHO ASSIST). This study is a one group, cross-sectional, health assessment study. Participants who enroll in the study will complete on-line surveys at a single time point. Approximately 1,523 patients will be recruited from approximately 15 community community pharmacies. Trained pharmacy staff will inform potentially eligible participants, or individuals receiving at least one prescription(s) for potentially eligible participants, of the survey opportunity. Patients recruited will complete validated measures to assess opioid use and risk behaviors, substance use, and physical and mental health. A series of a priori analyses will be conducted to evaluate the validity of the PDMP-based opioid risk metric relative to the widely validated gold standard WHO ASSIST and to identify cutoff thresholds. Correlational, regression, and Cohen's Kappa statistical analyses will also be conducted to evaluate the relationship between the risk metric and the WHO ASSIST.
Interventions
None listed
Sponsors
University of Cincinnati
Purdue University
National Institute on Drug Abuse (NIDA)
University of Utah
Study design
Observational model
OTHER
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
1. be dispensed ≥1 opioid medication (including tramadol) by a participating pharmacy; 2. be ≥18 years of age according to pharmacy data and self-report
Exclusion criteria
1. solely filling buprenorphine or buprenorphine combination products i.e., patients receiving OUD treatment with no other opioid medication use; 2. currently receiving treatment for cancer; 3. having previously completed the survey; 4. having current involvement with the criminal justice system that has, or could, lead to incarceration
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Validity of the PDMP Narcotic Score Versus the WHO ASSIST | The ASSIST was administered once at Day 1. | To assess the validity of the PDMP Narcotic Score, the AUC (Area Under the Curve) was used. AUC ranges in value from 0 to 1. A model whose predictions are 100% wrong has an AUC of 0.0; one whose predictions are 100% correct has an AUC of 1.0. And when AUC is 0.5, it means the model has no means of separating between the different groups. For this study, the closer to 1.0 the more similar the PDMP Narcotic Score is to the WHO ASSIST. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| All Participants Study participants were patients of one of the 19 study pharmacies, completed the survey, and had sufficient data in the prescription drug monitoring program to generate the Narcotic Score (NS) | 1,464 |
| Total | 1,464 |
Baseline characteristics
| Characteristic | All Participants |
|---|---|
| Age, Continuous | 49.6 years STANDARD_DEVIATION 14.8 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 17 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 1447 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Prescription Opioids High | 33 Participants |
| Prescription Opioids Low | 772 Participants |
| Prescription Opioids Moderate | 623 Participants |
| Prescription Opioids Unknown/Not responded | 36 Participants |
| Sex: Female, Male Female | 911 Participants |
| Sex: Female, Male Male | 553 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 0 |
| other Total, other adverse events | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 |
Outcome results
Primary
Validity of the PDMP Narcotic Score Versus the WHO ASSIST
To assess the validity of the PDMP Narcotic Score, the AUC (Area Under the Curve) was used. AUC ranges in value from 0 to 1. A model whose predictions are 100% wrong has an AUC of 0.0; one whose predictions are 100% correct has an AUC of 1.0. And when AUC is 0.5, it means the model has no means of separating between the different groups. For this study, the closer to 1.0 the more similar the PDMP Narcotic Score is to the WHO ASSIST.
Time frame: The ASSIST was administered once at Day 1.
Population: Participants who complete the World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST).
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| High to Moderate Risk | Validity of the PDMP Narcotic Score Versus the WHO ASSIST | .70 probability |
| Moderate to Low Risk | Validity of the PDMP Narcotic Score Versus the WHO ASSIST | .74 probability |