title: Development of a brief tool for monitoring aberrant behaviours among patients receiving long-term opioid therapy: The Opioid-Related Behaviours In Treatment (ORBIT) scale.
abstract: BACKGROUND
  Early identification of problems is essential in minimising the unintended consequences of opioid therapy. This study aimed to develop a brief scale that identifies and quantifies recent aberrant behaviour among diverse patient populations receiving long-term opioid treatment.
  
  
  METHODS
  40 scale items were generated via literature review and expert panel (N=19) and tested in surveys of: (i) N=41 key experts, and (ii) N=426 patients prescribed opioids >3 months (222 pain patients and 204 opioid substitution therapy (OST) patients). We employed item and scale psychometrics (exploratory factor analyses, confirmatory factor analyses and item-response theory statistics) to refine items to a brief scale.
  
  
  RESULTS
  Following removal of problematic items (poor retest-reliability or wording, semantic redundancy, differential item functioning, collinearity or rarity) iterative factor analytic procedures identified a 10-item unifactorial scale with good model fit in the total sample (N=426; CFI=0.981, TLI=0.975, RMSEA=0.057), and among pain (CFI=0.969, TLI=0.960, RMSEA=0.062) and OST subgroups (CFI=0.989, TFI=0.986, RMSEA=0.051). The 10 items provided good discrimination between groups, demonstrated acceptable test-retest reliability (ICC 0.80, 95% CI 0.60-0.89; Cronbach's alpha=0.89), were moderately correlated with related constructs, including opioid dependence (SDS), depression and stress (DASS subscales) and Social Relationships and Environment domains of the WHO-QoL, and had strong face validity among advising clinicians.
  
  
  CONCLUSIONS
  The Opioid-Related Behaviours In Treatment (ORBIT) scale is brief, reliable and validated for use in diverse patient groups receiving opioids. The ORBIT has potential applications as a checklist to prompt clinical discussions and as a tool to quantify aberrant behaviour and assess change over time.
authors.affiliation: National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW 2052, Australia. Electronic address: b.larance@unsw.edu.au.
authors.forename: Briony
authors.initials: B
authors.lastname: Larance
authors.affiliation: School of Medicine, University of Tasmania, Sandy Bay Campus, Hobart, Tasmania 7001, Australia.
authors.forename: Raimondo
authors.initials: R
authors.lastname: Bruno
authors.affiliation: The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, 591 South Dowling Street, Surry Hills, NSW 2010, Australia; University of Sydney, Camperdown, NSW 2050, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lintzeris
authors.affiliation: National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW 2052, Australia; School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, VIC 3052, Australia; Department of Global Health, School of Public Health, University of Washington, 325 9th Avenue, Seattle, WA 98104, USA.
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
authors.affiliation: National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW 2052, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Black
authors.affiliation: Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Brown
authors.affiliation: National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW 2052, Australia; University of Sydney, Camperdown, NSW 2050, Australia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Nielsen
authors.affiliation: Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia; School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
authors.forename: Adrian
authors.initials: A
authors.lastname: Dunlop
authors.affiliation: Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia.
authors.forename: Rohan
authors.initials: R
authors.lastname: Holland
authors.affiliation: St Vincent's Clinical School, UNSW Australia, Darlinghurst, NSW 2010, Australia.
authors.forename: Milton
authors.initials: M
authors.lastname: Cohen
authors.affiliation: National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW 2052, Australia.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Mattick
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000009:adverse effects*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000523:psychology*; D000066553:Problem Behavior / Q000523:psychology*; D011594:Psychometrics; D015203:Reproducibility of Results
chemical_list: D000701:Analgesics, Opioid
keywords: Addiction; Chronic pain; Medication non-adherence; Opioid analgesics; Opioid substitution therapy