CTN-0093: Validation of a Community Pharmacy-based Prescription Drug Monitoring Program Risk Screening Tool (PHARMSCREEN)
Gerald Cochran, MSW, PhD
Co-Lead Investigator
University of Utah School of Medicine
gcochran@pitt.edu
T. John Winhusen, PhD
Co-Lead Investigator
University of Cincinnati
Addiction Sciences Division
winhust@ucmail.uc.edu
Community pharmacies are optimal — yet underutilized — settings for identifying individuals with opioid use disorder (OUD) and increasing their access to treatment. Approximately 93% of individuals in the U.S. live within 5 miles of a community pharmacy. The most common opioid-related tool available to pharmacists is the prescription drug monitoring program (PDMP), which systems provide highly limited information and support for clinical decision making. Appriss Health, the largest U.S. PDMP vendor covering 42 states, has developed an opioid risk measure, the NarxScore. This study will clinically validate the NarxScore metric and identify high, moderate, and low opioid risk thresholds to inform OUD care management within urban and rural community pharmacies. This is a prospective cross-sectional comprehensive OUD risk and behavioral/physical health survey administered electronically with patients (N=1,523) filling opioid medications in urban/rural community pharmacies in Ohio (pharmacy sites: n=12) and Indiana (pharmacy: sites n=3), states which continue to have disproportionately high rates of overdose and opioid prescribing. Correlation, regression, and Kappa statistics will be calculated for validation; receiver operating curves with sensitivity/specificity values will be employed for threshold identification (with >95% power to detect a 0.7 area under the curve value).
Funded by the NIH HEAL InitiativeSM.
Primary Findings
Prior to this study, clinically useful risk thresholds and the validity of Narcotic Score metric have not been established. Community pharmacies are underutilized settings to address the opioid epidemic. This prescription drug monitoring program’s (PDMP’s) Narcotic Score metric is a screening tool with fair discriminative accuracy and fair to moderate concurrent validity to detect recent risky prescription opioid use as measured by the WHO ASSIST. The Narcotic Score metric could serve as a clinically useful universal prescription opioid use-risk screener in community pharmacies.
Primary Outcomes Article: Cochran et al. Validation and threshold identification of a prescription drug monitoring program clinical opioid risk metric with the WHO alcohol, smoking, and substance involvement screening test. Drug and Alcohol Dependence 2021;228:109067. [get article]
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