title: A multicenter, primary care-based, open-label study to identify behaviors related to prescription opioid misuse, abuse, and diversion in opioid-experienced patients with chronic moderate-to-severe pain.
abstract: OBJECTIVE
  To compare the investigator assessment of patient risk for prescription opioid misuse, abuse, and diversion with patient self-reports of these activities in a population with chronic pain.
  
  
  METHODS
  As a secondary objective of an open-label, multicenter, primary care-based clinical study to evaluate the success of converting opioid-experienced patients with chronic pain to morphine sulfate with sequestered naltrexone hydrochloride, risk for misuse, abuse, and diversion was assessed using two nonvalidated questionnaires: one was completed by the investigator and another by the patient (Self-Reported Misuse, Abuse, and Diversion [SR-MAD]). In addition, the validated Current Opioid Misuse Measure (COMM) test and urine drug test were used.
  
  
  RESULTS
  Of the 684 patients assessed by the investigators, 537 returned the self-assessment, SR-MAD. Most patients were assigned by the investigator as low risk for misuse (84.2%), abuse (89.3%), and diversion (94.3%). Of the patients who returned SR-MAD, 60% indicated having taken more opioids than prescribed and 10.9% reported chewing or crushing their opioids in the past. Of the patients who completed COMM, 40.6% were deemed as having aberrant behaviors. COMM results correlated with the risk levels from the investigator assessment. One-third of patients (33.8%) had at least one abnormal urine drug test result.
  
  
  CONCLUSIONS
  More research is needed to better understand the gap between the investigator assessment of potential risk for misuse, abuse, and diversion and the actual extent of these behaviors among patients with chronic pain.
authors.affiliation: Pfizer Inc, Durham, NC, USA.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Setnik
authors.affiliation: Pfizer Inc, Durham, NC, USA.
authors.forename: Carl L
authors.initials: CL
authors.lastname: Roland
authors.affiliation: Pfizer Inc, Durham, NC, USA ; Duke University Medical Center, Durham, NC, USA.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Sommerville
authors.affiliation: Pfizer Inc, Durham, NC, USA.
authors.forename: Glenn C
authors.initials: GC
authors.lastname: Pixton
authors.affiliation: Family Health Medical Services PLLC, Mayville, NY, USA ; Department of Social and Preventive Medicine, State University of New York at Buffalo, Buffalo, NY, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Berke
authors.affiliation: New York Spine & Wellness Center, Syracuse, NY, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Calkins
authors.affiliation: Pfizer Inc, Durham, NC, USA ; Duke University Medical Center, Durham, NC, USA.
authors.forename: Veeraindar
authors.initials: V
authors.lastname: Goli
keywords: abuse; chronic pain; diversion; misuse; opioid