Morasco Benjamin J, Iacocca Megan O, Lovejoy Travis I, Dobscha Steven K, Deyo Richard A, Cavese Julie A, Hyde Stephanie, Yarborough Bobbi Jo H
Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System.
Department of Family Medicine, Oregon Health & Science University.
Psychol Serv. 2021 Aug;18(3):319-327. doi: 10.1037/ser0000471. Epub 2020 Jul 16.
Identifying patients at risk of misusing prescription opioids is a priority. Standardized risk measures exist, but prior research has been limited in an assessment of their utility by a reliance on cross-sectional or retrospective analyses. In this study, the Pain Medication Questionnaire (PMQ), a standardized self-report measure of risk for prescription opioid misuse, was used to predict aberrant urine drug test (UDT) results over the subsequent 24 months. At baseline, participants who were prescribed long-term opioid therapy completed self-report measures assessing pain, function, and quality of life; this also included the PMQ. Medical record data were abstracted for 24 months postbaseline to collect results of UDTs administered during clinical care. Among participants, 12.9% had a UDT result that was positive for a nonprescribed or illicit substance, 18.9% had an aberrant negative UDT result, 3.6% had aberrant positive and negative UDT results, and the remaining 64.6% had expected UDT results. Average PMQ score at baseline did not significantly differ based on participants' type of UDT result over 24 months of follow-up. Participant variables that were significantly associated with a subsequent aberrant positive UDT were higher prescription opioid dose and hazardous alcohol use; those associated with an aberrant negative UDT were lower prescription opioid dose and hazardous alcohol use; no variable was associated with combined positive and negative UDT results. In conclusion, total PMQ score was not predictive of aberrant positive or negative UDT results. More work is needed to identify optimal strategies of screening for risk of aberrant UDT results. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
识别有滥用处方阿片类药物风险的患者是当务之急。虽然存在标准化的风险评估方法，但先前的研究在评估其效用时，因依赖横断面分析或回顾性分析而受到限制。在本研究中，疼痛药物问卷（PMQ）作为一种标准化的自我报告式处方阿片类药物滥用风险评估工具，被用于预测随后24个月内异常尿液药物检测（UDT）结果。在基线时，接受长期阿片类药物治疗的参与者完成了评估疼痛、功能和生活质量的自我报告测量，这其中也包括PMQ。在基线后的24个月内提取病历数据，以收集临床护理期间进行的UDT结果。在参与者中，12.9%的人UDT结果显示存在未处方或非法物质呈阳性，18.9%的人UDT结果异常为阴性，3.6%的人UDT结果异常既有阳性又有阴性，其余64.6%的人UDT结果正常。在24个月的随访中，根据参与者的UDT结果类型，基线时的平均PMQ得分没有显著差异。与随后异常阳性UDT结果显著相关的参与者变量是较高剂量的处方阿片类药物和危险饮酒；与异常阴性UDT结果相关的变量是较低剂量的处方阿片类药物和危险饮酒；没有变量与UDT结果同时出现阳性和阴性相关。总之，PMQ总分不能预测异常阳性或阴性UDT结果。需要开展更多工作来确定筛查异常UDT结果风险的最佳策略。（PsycInfo数据库记录（c）2021美国心理学会，保留所有权利）
