Screening for controlled substance abuse in interventional pain management settings: evaluation of an assessment tool

There is a need for an assessment tool to identify drug abuse behaviors in patients in pain treatment practices. Many assessment tools are complex, lengthy, lack external validation, and/or are difficult to administer. This prospective evaluation was undertaken to provide external validation for an assessment tool with 12 sections and 27 items. The test was applied in a prospective fashion to 500 consecutive patients: 100 patients in a drug abuse group and 400 patients in a non-abuse group. Drug abuse was defined as the misuse of controlled substances in a clinical setting, including obtaining controlled substances from other physicians or other identifiable sources, dose escalation with inappropriate use, and/or violation of controlled substance agreements. This study was performed in an interventional pain management setting with patients who were in stable therapy and were followed for at least one year. Results identified 8 of 12 parameters to be useful in identifying patients with drug abuse. Three factors were particularly useful, allowing correct identification of patients with abuse behavior in 90% of cases (odds ratios greater than 100 and P values of 0.001 or less). Important factors identified included excessive opiate needs, deception or lying to obtain controlled substances, and current or prior intentional doctor shopping. Together, these factors appear to identify 90% of patients with drug abuse. This tool provides a simple, reliable, and cost effective means of screening for drug abuse during the clinical evaluation of patients in interventional pain management settings.