Prescription Opioid Misuse Index in sickle cell patients: A brief questionnaire to assess at-risk for opioid abuse

Wally R. Smith, MD; Donna K. McClish, PhD; John D. Roberts, MD; Osama Kandalaft, MD; Bassam Dahman, PhD; Janet Knisely, PhD; James Levenson, MD; Susan Roseff, MD; Imo P. Aisiku, MD

doi:10.5055//jom.2019.0517

Authors

Wally R. Smith, MD
Donna K. McClish, PhD
John D. Roberts, MD
Osama Kandalaft, MD
Bassam Dahman, PhD
Janet Knisely, PhD
James Levenson, MD
Susan Roseff, MD
Imo P. Aisiku, MD

DOI:

https://doi.org/10.5055//jom.2019.0517

Keywords:

sickle cell, opioid, addiction, pain, survey, abuse

Abstract

Objective: To develop a survey instrument to identify adult sickle cell disease (SCD) patients on chronic opioid therapy who are at-risk for opioid abuse.

Design: Prospective survey and interview.

Setting: Adult SCD clinic in a large urban teaching facility.

Patients/participants: Convenience sampling of adult patients presenting to the sickle cell clinic.

Interventions: None.

Main outcome: Primary outcome was “at-risk for opioid misuse,” defined as at least 3/8 “yes” answers (a positive composite score) on the Prescription Opioid Misuse Index (POMI) questionnaire. Secondary outcome was DSM-IV criteria for substance abuse using the DSM IV Diagnostic Interview Schedule.

Results: Of the 99 patients who completed the POMI, the mean age was 36 years; 58.6 percent were female, 48 percent were hemoglobin SS (47/99), and 26 percent were SC (26/99). Twenty-four percent (24/99) were identified as at-risk for opioid misuse using the POMI. There were no differences in demographic, SCD genotype, or socioeconomic variables for at-risk versus not-at-risk patients.

Conclusion: Twenty-four percent of unselected adult SCD patients on opioids were identified as at-risk for opioid misuse using a quick survey. This may represent as much as 2.5-7 times the national misuse rate. This group of patients may benefit from additional diagnostic and therapeutic interventions to help understand and manage their opioid usage.

Author Biographies

Wally R. Smith, MD

Professor, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia

Donna K. McClish, PhD

Professor, Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia

John D. Roberts, MD

Professor, Department of Medicine, Yale University, New Haven, Connecticut

Osama Kandalaft, MD

Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts

Bassam Dahman, PhD

Assistant Professor, Department of Healthcare Policy and Research, Virginia Commonwealth University, Richmond, Virginia

Janet Knisely, PhD

Associate Professor, Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia

James Levenson, MD

Professor, Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia

Susan Roseff, MD

Professor, Department of Pathology, Virginia Commonwealth University, Richmond, Virginia.

Imo P. Aisiku, MD

Assistant Professor, Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts

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