EVIDENCE-BASED ANSWER
No, there is no well-tested, easily administered screening tool to detect drug-seeking behaviors in primary care patients taking long-term opioids or being considered for such therapy (strength of recommendation [SOR]: C, studies of intermediate outcomes). Several tools have undergone preliminary testing in pain centers and are being tested in different settings with larger numbers of patients.
For primary care providers, a useful screening tool for predicting drug-seeking behaviors is the Screener and Opioid Assessment for Patients with Pain (SOAPP-R; SOR: C, studies of intermediate outcomes). Drug-seeking behavior in patients on long-term opioid therapy can be monitored with the Current Opioid Misuse Measure (COMM; SOR: C, studies of intermediate outcomes).
Evidence summary
Drug-seeking behaviors—known as aberrant behaviors in chronic pain literature—may suggest a substance abuse disorder (TABLE).2 At least 4 validated screening tools are available for predicting or monitoring aberrant behaviors in patients with chronic, nonmalignant pain disorders who are being considered for, or receiving, opioid therapy:
The Screener and Opioid Assessment for Patients with Pain (SOAPP-R) is a 24-item, self-administered questionnaire that stratifies patients being considered for opioid therapy into lower or higher risk for future opioid-related aberrant behaviors.2 Each item queries frequency of behaviors and emotions consistent with opioid misuse and can be scored as 0 (never) to 4 (very often). The items on the SOAPP-R were developed by a consensus panel of pain and addiction experts.
In a multidisciplinary pain center study, the SOAPP-R was administered to 283 chronic pain patients who were followed for 5 months. At a cutoff score of ≥18, the test had a positive likelihood ratio (LR+) of 3.80 and a negative likelihood ratio (LR–) of 0.29 for detecting opioid misuse. At this cutoff, the SOAPP-R was 81% sensitive and 68% specific for predicting patients at high risk for aberrant behavior.