From the New York University Grossman School of Medicine, New York, NY (AMB, JM); Friends Research Institute, Baltimore, MD (RPS); Duke University School of Medicine, Durham, NC (L-TW); The Emmes Company, Rockville, MD (AW, MK); and National Institute on Drug Abuse, Rockville, MD (GS).
J Addict Med. 2023;17(4):471-473. doi: 10.1097/ADM.0000000000001139. Epub 2023 Feb 4.
This secondary analysis evaluated opioid-specific validation results of the Tobacco, Alcohol, Prescription Medication, and Other Substances (TAPS) tool for screening in primary care.
This study is a secondary data analysis of the TAPS validation study. Performance of the TAPS tool for screening for unhealthy opioid use (with a score of 1+ for heroin and/or prescription opioids representing a positive screen) was evaluated. Discriminative ability was examined in comparison with reference standard measures across the spectrum of unhealthy opioid use: timeline follow-back with and without oral fluid testing identifying past-month use and the modified Composite International Diagnostic Interview for past-year problem use, opioid use disorder (OUD), and moderate-severe OUD.
In a sample of 2000 primary care patients, 114 screened positive for opioids on the TAPS tool. With a TAPS cutoff equal to 1+, the TAPS accurately identified past-month use, problem use, any OUD, and moderate-severe OUD (sensitivities = 68%-85%, specificities = 97%-98%, area under the curve = 0.80-0.91). When past-month use was expanded to include timeline follow-back with oral fluid testing, accuracy declined (52% sensitivity [95% confidence interval, 43%-60%], 98% specific [95% confidence interval, 97%-98%]).
While further testing in a larger population sample may be warranted, given their brevity, simplicity, and accuracy when self-administered, the TAPS opioid items can be used in primary care settings for a spectrum of unhealthy opioid use; however, self-disclosure remains an issue in primary care settings.
本二次分析评估了用于初级保健筛查的烟草、酒精、处方药物和其他物质（TAPS）工具的阿片类药物特异性验证结果。
本研究是 TAPS 验证研究的二次数据分析。评估了 TAPS 工具用于筛查不健康阿片类药物使用（使用海洛因和/或处方阿片类药物的评分≥1 表示阳性筛查）的性能。通过与参考标准措施（包括使用 Timeline Follow-Back 结合和不结合口腔液测试来识别过去一个月的使用情况，以及经过修改的复合国际诊断访谈来识别过去一年的问题使用、阿片类药物使用障碍和中重度阿片类药物使用障碍）比较，评估了该工具的鉴别能力。
在 2000 名初级保健患者的样本中，有 114 名患者 TAPS 工具筛查出阿片类药物阳性。TAPS 截止值等于 1+时，TAPS 准确识别了过去一个月的使用情况、问题使用、任何阿片类药物使用障碍和中重度阿片类药物使用障碍（敏感度=68%-85%，特异性=97%-98%，曲线下面积=0.80-0.91）。当过去一个月的使用情况扩大到包括使用 Timeline Follow-Back 结合口腔液测试时，准确性下降（敏感度 52%[95%置信区间，43%-60%]，特异性 98%[95%置信区间，97%-98%]）。
鉴于其简洁性、简单性和自我评估时的准确性，如果在更大的人群样本中进一步测试，TAPS 阿片类药物项目可用于初级保健环境中，以识别各种不健康的阿片类药物使用情况；然而，自我披露仍然是初级保健环境中的一个问题。
