Development of SCOPE: Social and Clinical Opioid Use Disorder Predisposition Evaluation

Our study aimed to identify social determinants of health (SDoH), demographic, and clinical features associated with opioid use disorder (OUD) and then to develop a risk calculator, termed Social and Clinical Opioid Use Disorder Predisposition Evaluation (SCOPE), that clinicians may use at the bedside to risk-stratify for OUD.

Participant data from the All of Us Research Program were used. Multivariable logistic regression was used to identify various SDoH, demographic, and clinical predictors for OUD. The dependent variable of OUD was defined as occurring ≥90 days after participants completed a survey that queried questions related to SDoH. Calculated odds ratios from the model were used to construct a score-based calculator, SCOPE, and model performance was measured by area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity.

There were 624,431 included participants, of whom 2475 (0.39%) had OUD that was diagnosed >90 days after survey completion. SCOPE's performance was assessed using 10-fold cross-validation, resulting in an average AUROC [SD] of 0.85 [0.011], specificity of 78% [0.16%], and sensitivity of 78% [2.42%]. Defining a cutoff score of 8 as high-risk yielded a sensitivity of 0.79 [95% CI: 0.76-0.83], specificity of 0.76 [95% CI: 0.75-0.76], positive likelihood ratio of 3.35, and negative likelihood ratio of 0.26.

We identified individual- and SDoH-related risk factors for OUD and developed SCOPE, which may be used as a clinical decision-making aid for personalized risk identification of OUD.