Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA Youth Alcohol Prevention Center, Boston University School of Public Health, Boston, MA, USA Department of Social and Behavioral Sciences, Boston University School of Public Health, Boston, MA, USA Inflexxion, Inc., Newton, MA, USA.
Pain. 2011 Feb;152(2):397-402. doi: 10.1016/j.pain.2010.11.006. Epub 2010 Dec 21.
The Current Opioid Misuse Measure (COMM), a self-report assessment of past-month aberrant medication-related behaviors, has been validated in specialty pain management patients. The performance characteristics of the COMM were evaluated in primary care (PC) patients with chronic pain. It was hypothesized that the COMM could identify patients with prescription drug use disorder (PDD). English-speaking adults awaiting PC visits at an urban, safety-net hospital, who had chronic pain and had received any opioid analgesic prescription in the past year, were administered the COMM. The Composite International Diagnostic Interview served as the "gold standard," using DSM-IV criteria for PDD and other substance use disorders (SUDs). A receiver operating characteristic (ROC) curve demonstrated the COMM's diagnostic test characteristics. Of the 238 participants, 27 (11%) met DSM-IV PDD criteria, whereas 17 (7%) had other SUDs, and 194 (82%) had no disorder. The mean COMM score was higher in those with PDD than among all others (ie, those with other SUDs or no disorder, mean 20.4 [SD 10.8] vs 8.4 [SD 7.5], P<.0001). A COMM score of⩾13 had a sensitivity of 77% and a specificity of 77% for identifying patients with PDD. The area under the ROC curve was 0.84. For chronic pain patients prescribed opioids, the development of PDD is an undesirable complication. Among PC patients with chronic pain-prescribed prescription opioids, the COMM is a promising tool for identifying those with PDD. Among primary care patients with chronic pain-prescribed opioids, the validated Current Opioid Misuse Measure (COMM) is a promising tool for identifying patients with prescription opioid use disorder.
当前阿片类药物滥用量表（COMM）是一种评估过去一个月内异常药物相关行为的自我报告评估方法，已在专业疼痛管理患者中得到验证。在接受慢性疼痛治疗的初级保健（PC）患者中评估了 COMM 的性能特征。假设 COMM 可以识别出患有处方药物使用障碍（PDD）的患者。在城市安全网医院等待 PC 就诊的讲英语的成年人，他们患有慢性疼痛，并且在过去一年中接受过任何阿片类镇痛药处方，接受了 COMM 评估。综合国际诊断访谈作为“金标准”，使用 DSM-IV 标准诊断 PDD 和其他物质使用障碍（SUD）。受试者工作特征（ROC）曲线显示了 COMM 的诊断测试特征。在 238 名参与者中，有 27 名（11％）符合 DSM-IV PDD 标准，17 名（7％）患有其他 SUD，194 名（82％）没有障碍。患有 PDD 的患者的平均 COMM 评分高于所有其他患者（即患有其他 SUD 或无障碍的患者，平均值为 20.4[SD 10.8] vs 8.4[SD 7.5]，P<.0001）。COMM 评分⩾13 时，对识别 PDD 患者的敏感性为 77％，特异性为 77％。ROC 曲线下面积为 0.84。对于开具阿片类药物的慢性疼痛患者，PDD 的发展是一种不良并发症。在开具处方阿片类药物治疗慢性疼痛的 PC 患者中，COMM 是识别 PDD 患者的有前途的工具。在开具阿片类药物治疗慢性疼痛的初级保健患者中，经过验证的当前阿片类药物滥用量表（COMM）是识别处方阿片类药物使用障碍患者的有前途的工具。
