Validation and threshold identification of a prescription drug monitoring program clinical opioid risk metric with the WHO Alcohol, Smoking, and Substance Involvement Screening Test.

This is the primary outcomes paper for CTN-0093.

Prescription drug monitoring programs (PDMPs) are critical for pharmacists to identify risky opioid medication use. This study, an independent evaluation of the PDMP-based Narcotic Score (NS) metric, was a one-time, cross-sectional health assessment within 19 pharmacies from a national chain among adults picking up opioid medications. The NS metric is a 3-digit composite indicators. The WHO Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was the gold-standard to which the NS metric was compared. Machine learning determined optimal risk thresholds; Receiver Operating Characteristic curves an Spearman (P) and Kappa (K) coefficients analyzed concurrent validity. Regression analyses evaluated participant characteristics associated with misclassification.

The NS metric showed fair concurrent validity (area under the curve=0.70; K=0.35; P = 0.37, p < 0.001). The ASSIST and NS metric categorized 37% of participants as low-risk (i.e., not needing screening/intervention). Further, 17.2% were categorized as low ASSIST risk but moderate/high NS metric risk, termed false positives. These reported disability (OR=3.2), poor general health (OR=0.66), and/or greater pain severity/interference (OR=1.12/1.09; all p < 0.05; i.e., needing unmanaged-pain screening/intervention). A total of 13.4% were categorized as moderate/high ASSIST risk but low NS metric risk, termed false negatives. These reported greater overdose history (OR=1.24) and/or substance use (OR=1.81-12.66; all p < 0.05).

Conclusions: The NS metric could serve as a useful initial universal prescription opioid-risk screener given its: 1) low burden (i.e., no direct assessment); 2) high accuracy (86.5%) of actionable data identifying low-risk patients and those needing opioid use/unmanaged pain screening/intervention; and 3) broad availability.

Related protocols: CTN-0093