he field of risk assessment began with “red-flag lists.”
Portenoy1 offered one of these: a list of behaviors that were
thought to be indicative of potential misuse of medications.
Other authors followed with additional red-flag lists. Practitioners were then faced with a wide array of red-flag behaviors or characteristics, such as calling the practitioner by his or her
first name, having no primary care provider (PCP), being a smoker,
forging prescriptions, stealing medications from another patient, and
selling prescription drugs. Such red-flag lists
offered characteristics and behaviors for
practitioners to watch for, but patient actions
and “symptoms” were not scored or weighted. Although practitioners could use previously existing drug or alcohol abuse screening tools such as the CAGE (4 questions:
C u t - d o w n A n n o y e d G u i l t y
Eye-opener), the Michigan Alcohol Screening Test (MAST), the Drug Abuse Screening
Test (DAST), and the Screening Instrument
for Substance Abuse Potential (SISAP), these
did not apply well to a population of chronic
pain patients in whom nonpathologic physical dependence is often the norm. Thus,
these screening tools were of limited value
(although they are sometimes still used today
in some settings).
Screening tools designed specifically for use
with chronic pain patients began emerging
within the last 10 years. These included the
Screener and Opioid Assessment for Patients
with Pain (SOAPP, 2004); the Pain Medication Questionnaire (PMQ, 2004); the Opioid
Risk Tool (ORT, 2004); the Diagnosis, Intractability, Risk, Efficacy instrument (DIRE,
2006); and the SOAPP-revised (SOAPP-R,
2008). These measures helped clinicians
predict future misuse of opioid medications
by enabling the calculation of scores with
norms, and cut-offs were used to place patients in categories of low, medium, or high
risk for future medication aberrant behaviors.
IN OUR
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SeeMeD
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NUMBeR OF
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NUMBeR OF
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