National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, New South Wales, Australia.
Monash Addiction Research Centre, Monash University Peninsula Campus, Frankston, Victoria, Australia.
Pain Med. 2020 Feb 1;21(2):e79-e88. doi: 10.1093/pm/pnz213.
To develop a short, patient-administered screening tool that will allow for earlier assessment of prescription opioid dependence (often referred to as addiction) in primary care settings.
Cross-sectional analysis (N = 1,134) from the two-year time point of the Pain and Opioids IN Treatment (POINT) cohort was used in the scale development.
Participants who completed two-year interviews in the POINT study, a prospective cohort study that followed people with chronic noncancer pain over a five-year period, and who were prescribed strong opioids for a minimum of six weeks at baseline.
An advisory committee provided advice on wording and content for screening in primary care settings. Univariate logistic regression identified individual items that were significantly associated with meeting ICD-11 criteria for prescription opioid dependence. Exploratory and confirmatory factor analysis (EFA and CFA) were conducted, and items were reduced to identify a small item set that were discriminative and shared a simple underlying structure.
Sixty-four variables associated with ICD-11 criteria for prescription opioid dependence were initially identified. Four rounds of EFA were performed, resulting in five items remaining. CFA identified two possible four-item combinations, with the final combination chosen based on greater item endorsement and the results of goodness-of-fit indices.
Addressing prescription opioid dependence is an important part of the global public health challenge surrounding rising opioid-related harm. This study addresses an important initial requisite step to develop a brief screening tool. Further studies are required to validate the tool in clinical settings.
开发一种简短的、由患者自行管理的筛选工具，以便在初级保健环境中更早地评估处方阿片类药物依赖（通常称为成瘾）。
来自为期两年的疼痛和阿片类药物治疗（POINT）队列的横断面分析（N=1134）用于量表开发。
在 POINT 研究中完成两年访谈的参与者，这是一项前瞻性队列研究，对患有慢性非癌症疼痛的人群进行了五年的随访，并在基线时至少开处强阿片类药物治疗六周。
咨询委员会就初级保健环境中的筛选提供了措辞和内容方面的建议。单变量逻辑回归确定了与符合 ICD-11 处方阿片类药物依赖标准显著相关的个别项目。进行了探索性和验证性因素分析（EFA 和 CFA），并减少项目以确定具有区分力且共享简单潜在结构的小项目集。
最初确定了 64 个与 ICD-11 处方阿片类药物依赖标准相关的变量。进行了四轮 EFA，最终留下了五个项目。CFA 确定了两种可能的四项组合，最终组合是基于更多项目的认可和良好拟合指数的结果选择的。
解决处方阿片类药物依赖是解决与阿片类药物相关危害上升相关的全球公共卫生挑战的重要组成部分。本研究为开发简短的筛选工具迈出了重要的初步步骤。需要进一步的研究来验证该工具在临床环境中的有效性。
