title: Prescription opioid abuse and misuse: gap between primary-care investigator assessment and actual extent of these behaviors among patients with chronic pain.
abstract: OBJECTIVE
  To compare the results of two open-label primary care-based studies that examined investigator assessment of patient risk for prescription opioid misuse, abuse, and diversion relative to patient self-reports and urine drug tests (UDTs).
  
  
  METHODS
  Risk assessment data from two open-label, multicenter, primary care-based US studies in patients with chronic pain were compared.
  
  
  RESULTS
  In one study (n = 1487), 54.4% of patients were at moderate, 24.8% at high, and 20.8% at low risk based on patients' self-reports at baseline on the Screener and Opioid Assessment for Patients with Pain®-Revised questionnaire. Investigators assigned 1.3% of patients as high risk despite 5.0% self-reporting prior illicit drug use and 15.3% with positive UDT(s) for an illicit drug at baseline. In the second study (n = 684), few patients were considered by investigators to be at high risk for misuse (1.6%), abuse (1.8%), or diversion (1.0%). However, 10.4% of patients reported prior illicit drug use; 23.4% had at least one abnormal baseline UDT; 60% of 537 patients reported on the Self-Reported Misuse, Abuse, and Diversion questionnaire they took more opioids than prescribed; and 10.9% reported chewing/crushing opioids in the past. Of patients completing the Current Opioid Misuse Measure, 40.6% were classified as having aberrant behaviors.
  
  
  CONCLUSIONS
  A comparison of risk assessment across two studies indicates a tendency for investigators to assess patients as lower risk for opioid-related aberrant behaviors despite a significant proportion self-reporting aberrant behavior and/or presenting with illicit UDTs. These consistent findings underline the importance of appropriate implementation of objective measures and self-reporting tools when evaluating risk in patients.
  
  
  BACKGROUND
  www.clinicaltrials.gov identifiers: NCT00640042 and NCT01179191.
authors: a Clinical Pharmacology , INC Research , Raleigh , NC , USA.
authors: Beatrice
authors: B
authors: Setnik
authors: b Department of Clinical Sciences and Outcomes & Evidence , Pfizer Inc , Durham , NC , USA.
authors: Carl L
authors: CL
authors: Roland
authors: c Department of Statistics , Pfizer Inc , Durham , NC , USA.
authors: Glenn C
authors: GC
authors: Pixton
authors: d Department of Clinical Research , GW Pharmaceuticals , Research Triangle Park , NC , USA.|e Department of Neurology , Duke University Medical Center , Durham , NC , USA.
authors: Kenneth W
authors: KW
authors: Sommerville
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000523:psychology* / Q000652:urine*; D063487:Prescription Drug Misuse; D011320:Primary Health Care / Q000379:methods*; D018570:Risk Assessment; D057566:Self Report; D015813:Substance Abuse Detection / Q000379:methods*; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: Abuse; chronic pain; diversion; misuse; opioid