Presented at the 2013 AAPM Annual Meeting « Back

Correlation of Misuse of Narcotics with Opioid Risk Tool and Pain Health Assessment: An Analysis of 16,000 Patients

Mark L. Gostine, MD, mlgostine@iserv.net¹, Fred N. Davis, MD², Gareth Forde, MD PhD³, Andrew Gostine, BS¹, Jana M. Mossey, PhD MPH MSN⁴, Graham T. Lubinsky, MA⁵, (1) Michigan Pain Consultants, Grand Rapids, Michigan, (2) ProCare Systems, Grand Rapids, Michigan, (3) UCI Medical Center, Irvine, California, (4) Drexel University School of Public Health, Philadelphia, Pennsylvania, (5) MSU-CHM, Grand Rapids, Michigan

Introduction: With the significant rise in prescription opioid overdoses since the mid 1990s, the CDC has called for “further defining populations at greater risk” as a critical element in the implementation of effective interventions1. The CDC also noted patients at risk for prescription overdose were much more likely receiving high dose narcotics exceeding 100 mg of morphine equivalent per day. We will analyze factors associated with narcotic misuse and high dose narcotic consumption. The first step is to capture and record patients who were overtly violating narcotic agreements. We have documented these miscreant behaviors with the appropriate diagnostic codes and notes in our EMR. Thresholds for the diagnosis of opioid misuse and abuse include: Abnormal urinary drug screens (UDS) Abnormal Michigan Automated Pharmacy Surveillance (MAPS) Behavior construed as drug seeking by experienced physicians and staff. We currently have over 16,000 patients in our practice with computerized Opioid Risk Tool2 scores and Pain Health Assessments (PHA) that detail behavioral and functional backgrounds and outcomes. We have de-identified and statistically analyzed pain health information and data collected from chronic pain patients in the practice using IRB approved language in their consent forms. The poster will describe a study of observed aberrant behavior associated with narcotic misuse, patients on high dose narcotics, and how these correlate with elements in the ORT and PHA. The goal will be to better identify and characterize patients at highest risk for prescription drug misuse and overdose. References: 1) http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6101a3.htm?s_cid=mm6101a3_w 2) Webster, L.R., Webster, R.M., Predicting Aberrant Behaviors in Opioid-Treated Patients: Preliminary Validation of the Opioid Risk Tool, Pain Medicine; Volume 6: Number 6, 2006; 432-442.

Funding: None.