Validation of the Routine Opioid Outcome Monitoring (ROOM) screening tool in patients prescribed opioids for chronic pain
Background: Large increases in opioid prescribing have occurred in many countries, and are associated with increased harms including dependence and mortality. An ongoing challenge has been how best to identify problematic opioid use in a therapeutic context, and how to incorporate screening into broader monitoring of outcomes with pain. This validation study examined a brief (12-item) screening tool to monitor clinical outcomes, including development of opioid use disorder, with prescribed opioids.
Methods: We recruited an online sample of 324 people who regularly used prescribed opioids for chronic pain. Participants had been experiencing pain on average for 9-10 years (IQR: 4-17 years) and using prescription opioids for 5 years (IQR 2.5-11 years) with the median number of prescription opioids currently taken being 2 (IQR: 1-2). One in four (24%) met DSM-5 criteria for moderate to severe opioid use disorder (OUD). We validated brief screening tools for pain, OUD, mood, risky alcohol use and constipation against longer screening tools and gold standard diagnostic assessments where available using Pearson’s rho and ROC statistics.
Results: With a cut-off of 3, the 4-item OUD screening tool had a sensitivity and specificity of 83.54% and 69.8% respectively, against DSM-5 (moderate to severe OUD). We found moderate to high correlation (0.64-0.73) between the briefer and the longer screening tools for pain, mood, alcohol use and constipation. Participants rated the brief tool with a median of 10 out of 10 for ease of, and time taken for completion.
Conclusion: We validated a brief self-complete screening tool for chronic pain patients prescribed opioids, which may help to identify opioid use disorder and other clinical problems in therapeutic settings. Results indicated that participants found the screening questions acceptable in both content and length.