"Checklist" spots opioid abuse in pain patients

NEW YORK (Reuters Health) - The Addiction Behaviors Checklist (ABC) is a useful assessment tool to measure inappropriate opioid use in patients with chronic pain, doctors report in the Journal of Pain and Symptom Management.

"Diagnosing addictive disease in patients with chronic nonmalignant pain has proven to be a clinical challenge," Dr. Bruce D. Naliboff, of the University of California, Los Angeles, and colleagues write. "Standardized diagnostic criteria for opioid addiction in pain-free populations have proven to be less than valid or difficult to apply in the context of chronic pain and therapeutic opioid prescription."

The ABC is a 20-item assessment tool designed to track behaviors that are characteristic of addiction to prescription opioids in chronic pain populations. Included in the study were 136 consecutive veterans, with chronic pain and a mean age of 53 years, who were receiving long-term opioid medication treatment.

Results of the study suggest that the Addiction Behaviors Checklist is reliable. The checklist showed good concurrent validity in terms of its relationship with global clinical judgments of appropriate opioid use.

According to Naliboff and colleagues, a cut-off score of 3 or more on the ABC is a good estimate of whether a patient is displaying inappropriate opioid use.

A total of 38 patients had their prescriptions discontinued because of objective misuse criteria established within the clinic setting. "The ABC mean score gradually increased, approaching a total mean score of 3, as the participants neared the final visit in which they were dropped due to problematic opioid medication use," Naliboff and colleagues explain.

Mean ABC scores for participants who either completed the study or were dropped due to non-problematic reasons tended to remain fairly stable around a mean score of about 1.2 to 1.3.

SOURCE: Journal of Pain and Symptom Management, October 2006.