A comparison of common screening methods for predicting aberrant drug-related behavior among patients receiving opioids for chronic pain management

Pain Med. 2009 Nov;10(8):1426-33. doi: 10.1111/j.1526-4637.2009.00743.x.


Objective: The ability to predict risk for violating opioid medication policies, known as aberrant drug-related behavior, is critical for providing optimal treatment. Many pain management centers measure risk using one of several partially validated measures: the Screener and Opioid Assessment for Patients with Pain (SOAPP), the Diagnosis, Intractability, Risk, and Efficacy inventory (DIRE), and/or the Opioid Risk Tool (ORT). However, little is known about how these measures compare with each other in predicting aberrant drug-related behavior and discontinuance of opioid pain medications. The current study aimed to address this research question.

Patients: Participants were 48 patients who attended a pain management center in Tennessee but were later discontinued from opioids for aberrant drug-related behavior. Patients referred for opioid medication for pain management participated in a semi-structured clinical interview with the staff psychologist and completed the aforementioned measures. Patients generally returned to the pain clinic on a monthly basis for medication management. Results. Analyses compared the sensitivity of each self-report measure and the clinical interview in predicting discontinuance for aberrant drug-related behavior.

Results: showed the highest sensitivity for the clinical interview (0.77) and the SOAPP (0.72), followed by the ORT (0.45) and the DIRE (0.17). Combining the clinical interview with the SOAPP increased sensitivity to 0.90.

Conclusions: Among patients who were discontinued from opioids for aberrant drug-related behaviors, the clinical interview and the SOAPP were most effective at predicting risk at baseline. Implications for future research and clinical practice are discussed.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Analgesics, Opioid / adverse effects*
  • Analgesics, Opioid / therapeutic use
  • Female
  • Humans
  • Interview, Psychological
  • Male
  • Mass Screening / methods*
  • Mental Disorders / diagnosis
  • Mental Disorders / prevention & control
  • Middle Aged
  • Neuropsychological Tests
  • Opioid-Related Disorders / diagnosis*
  • Opioid-Related Disorders / prevention & control*
  • Pain, Intractable / drug therapy*
  • Predictive Value of Tests
  • Risk Assessment
  • Risk Management / methods
  • Risk Management / statistics & numerical data
  • Risk Reduction Behavior
  • Sensitivity and Specificity


  • Analgesics, Opioid