First Response to Opioids Survey Tool (FROST): Pilot study of a brief screening tool to assess opioid use disorder risk

Sara L. Mills-Huffnagle; Christian Morris; Sarah Kawasaki; Grace E. Waverka; Haley A. Hammen; Aleksandra E. Zgierska

doi:10.5055/jom.0860

Authors

Sara L. Mills-Huffnagle, MS https://orcid.org/0000-0002-6722-2586
Christian Morris, BS
Sarah Kawasaki, MD
Grace E. Waverka, BA
Haley A. Hammen, BS
Aleksandra E. Zgierska, MD, PhD https://orcid.org/0000-0002-7773-6003

DOI:

https://doi.org/10.5055/jom.0860

Keywords:

initial opioid use, subjective experiences, opioid use disorder, opioid use disorder risk assessment

Abstract

Objective: Early work suggests the type of subjective experiences upon first opioid use may predict opioid use disorder (OUD) risk. This study developed and pilot-tested a brief survey to evaluate the “first response” to opioids.

Design: A cross-sectional survey research study. The survey was administered to a subsample for the second time to assess test–retest reliability.

Setting: Outpatient.

Participants: Convenience sample of adults treated for OUD at an opioid treatment program.

Main outcome measures: A seven-question First Response to Opioids Survey Tool (FROST), developed based on the existing questionnaires and stakeholder-advisor feedback, was evaluated.

Results: Participants (N = 157) were 36.8 (standard deviation [SD] = 9.4) years old, with 79.6 percent identifying as Caucasian and 56.7 percent male. They reported opioid initiation at 20.6 (SD = 8.8) years old, with a prescription-based (78.3 percent), orally administered (66.2 percent), and illicitly procured (51.0 percent) opioids. Upon opioid initiation, positive-valence, euphoria-like subjective experiences of feeling “comfortable” (65.0 percent), “happy” (61.1 percent), “euphoria” (58.6 percent), and “energized” (44.6 percent) were common, and different (p < 0.05) from other types of subjective experiences. Among 64 individuals who answered a question about “drug-liking,” 50 (78.1 percent) reported drug-liking. Among 31 respondents who completed the survey a second time, the test–retest consistency was 78.2 percent for subjective experience characteristics and 72 percent for drug-liking responses. Qualitative results corroborated quantitative findings.

Conclusion: These results suggest that euphoria-type experiences and drug-liking upon opioid initiation are common among adults with OUD and FROST's promising psychometric properties. Future research should assess clinical utility of this brief survey, which could be applied at bedside and help identify those at risk for OUD, guide safer opioid prescribing, and reduce opioid-related harm.

Author Biographies

Sara L. Mills-Huffnagle, MS

Graduate Student Fellow, Penn State College of Medicine, Hershey, Pennsylvania

Christian Morris, BS

Medical Student, Penn State College of Medicine, Hershey, Pennsylvania

Sarah Kawasaki, MD

Associate Professor, Penn State College of Medicine, Hershey, Pennsylvania

Grace E. Waverka, BA

Research Support, Penn State College of Medicine, Hershey, Pennsylvania

Haley A. Hammen, BS

Research Support, Penn State College of Medicine, Hershey, Pennsylvania

Aleksandra E. Zgierska, MD, PhD

Professor, Penn State College of Medicine, Hershey, Pennsylvania

References

Case A, Deaton A: Rising morbidity and mortality in midlife among White non-Hispanic Americans in the 21st century. Proc Natl Acad Sci U S A. 2015; 112(49): 15078-15083. DOI: 10.1073/pnas.1518393112. DOI: https://doi.org/10.1073/pnas.1518393112

Petterson S, Westfall JM, Miller BF: Projected deaths of despair during the coronavirus recession. Well Being Trust. 2020. Accessed at WellBeingTrust.org. Accessed May 19, 2023.

Centers for Disease Control and Prevention (CDC): Provisional drug overdose death counts. National Center for Health Statistics. February 14, 2024. Available at https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htmhttps://blogs.cdc.gov/nchs/2023/05/18/7365/#:~:text=The%2079%2C770%20reported%20opioid%2Dinvolved,80%2C997%20in%20the%20previous%20year. Accessed February 29, 2024.

Muhuri PK, Gfroerer JC, Davies MC: Associations of nonmedical pain reliever use and heroin initiation in the United States. CBHSQ Data Review. 2013. Available at https://www.samhsa.gov/data/sites/default/files/DR006/DR006/nonmedical-painreliever-use-2013.htm. Accessed May 5, 2023.

Vowles KE, McEntee ML, Julnes PS, et al.: Rates of opioid misuse, abuse, and addiction in chronic pain: A systematic review and data synthesis. Pain. 2015; 156(4): 569-576. DOI: 10.1097/01.j.pain.0000460357.01998.f1. DOI: https://doi.org/10.1097/01.j.pain.0000460357.01998.f1

National Institute of Drug Abuse (NIDA): Resource guide: Screening for drug use in general medical setting. 2012. Available at chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://nida.nih.gov/sites/default/files/pdf/screening_qr.pdf. Accessed May 5, 2023.

Bush K, Kivlahan DR, McDonell MB, et al.: The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Ambulatory care quality improvement project (ACQUIP). Alcohol use disorders identification test. Arch Intern Med. 1998; 158(16): 1789-1795. DOI: 10.1001/archinte.158.16.1789. DOI: https://doi.org/10.1001/archinte.158.16.1789

Johnson JA, Lee A, Vinson D, et al.: Use of AUDIT-based measures to identify unhealthy alcohol use and alcohol dependence in primary care: A validation study. Alcoholism Clin Exp Res. 2013; 37(1): E253-E259. DOI: 10.1111/j.1530-0277.2012.01898.x. DOI: https://doi.org/10.1111/j.1530-0277.2012.01898.x

Butler SF, Fernandez K, Benoit C, et al.: Validation of the revised screener and opioid assessment for patients with pain (SOAPP-R). J Pain. 2008; 9(4): 360-372. DOI: 10.1016/j.jpain.2007.11.014. DOI: https://doi.org/10.1016/j.jpain.2007.11.014

Webster LR, Webster RM: Predicting aberrant behaviors in opioid-treated patients: Preliminary validation of the opioid risk tool. Pain Med. 2005; 6(6): 432-442. DOI: 10.1111/j.1526-4637.2005.00072.x. DOI: https://doi.org/10.1111/j.1526-4637.2005.00072.x

Bond C, LaForge KS, Tian M, et al.: Single-nucleotide polymorphism in the human mu opioid receptor gene alters beta-endorphin binding and activity: Possible implications for opiate addiction. Proc Natl Acad Sci U S A. 1998; 95(16): 9608-9613. DOI: 10.1073/pnas.95.16.9608. DOI: https://doi.org/10.1073/pnas.95.16.9608

Mayer P, Rochlitz H, Rauch E, et al.: Association between a delta opioid receptor gene polymorphism and heroin dependence in man. Neuroreport. 1997; 8(11): 2547-2550. DOI: 10.1097/00001756-199707280-00025. DOI: https://doi.org/10.1097/00001756-199707280-00025

Yuferov V, Fussell D, LaForge KS, et al.: Redefinition of the human kappa opioid receptor gene (OPRK1) structure and association of haplotypes with opiate addiction. Pharmacogenetics. 2004; 14(12): 793-804. DOI: 10.1097/00008571-200412000-00002. DOI: https://doi.org/10.1097/00008571-200412000-00002

Zhang H, Kranzler HR, Yang BZ, et al.: The OPRD1 and OPRK1 loci in alcohol or drug dependence: OPRD1 variation modulates substance dependence risk. Mol Psychiatry. 2008; 13(5): 531-543. DOI: 10.1038/sj.mp.4002035. DOI: https://doi.org/10.1038/sj.mp.4002035

Blum K, Bowirrat A, Baron D, et al.: Biotechnical development of Genetic Addiction Risk Score (GARS) and selective evidence for inclusion of polymorphic allelic risk in substance use disorder (sud). J Syst Integr Neurosci. 2020; 6(2). DOI: 10.15761/JSIN.1000221. DOI: https://doi.org/10.15761/JSIN.1000221

Brant J: Duel in the Sun: Alberto Salazar, Dick Beardsley, and America's Greatest Marathon. Emmaus, PA: Rodale, 2006.

Morris CJ, Mills-Huffnagle S, Zgierska AE: Can the type of subjective response to first opioid exposure predict the risk of opioid use disorder? A scoping review. Brain Res Bull. 2022; 188: 67-76. DOI: 10.1016/j.brainresbull.2022.07.018. DOI: https://doi.org/10.1016/j.brainresbull.2022.07.018

Bieber CM, Fernandez K, Borsook D, et al.: Retrospective accounts of initial subjective effects of opioids in patients treated for pain who do or do not develop opioid addiction: A pilot case-control study. Exp Clin Psychopharmacol. 2008; 16(5): 429-434. DOI: 10.1037/1064-1297.16.5.429. DOI: https://doi.org/10.1037/1064-1297.16.5.429

Bruehl S, Burns JW, Passik SD, et al.: The contribution of differential opioid responsiveness to identification of opioid risk in chronic pain patients. J Pain. 2015; 16(7): 666-675. DOI: 10.1016/j.jpain.2015.04.001. DOI: https://doi.org/10.1016/j.jpain.2015.04.001

Bruehl S, Stone AL, Palmer C, et al.: Self-reported cumulative medical opioid exposure and subjective responses on first use of opioids predict analgesic and subjective responses to placebo-controlled opioid administration. Reg Anesth Pain Med. 2019; 44(1): 92-99. DOI: 10.1136/rapm-2018-000008. DOI: https://doi.org/10.1136/rapm-2018-000008

Agrawal A, Jeffries PW, Srivastava AB, et al.: Retrospectively assessed subjective effects of initial opioid use differ between opioid misusers with opioid use disorder (OUD) and those who never progressed to OUD: Data from a pilot and a replication sample. J Neurosci Res. 2022; 100(1): 353-361. DOI: 10.1002/jnr.24643. DOI: https://doi.org/10.1002/jnr.24643

Butler SF, Budman SH, Fernandez K, et al.: Validation of a screener and opioid assessment measure for patients with chronic pain. Pain. 2004; 112(1-2): 65-75. DOI: 10.1016/j.pain.2004.07.026. DOI: https://doi.org/10.1016/j.pain.2004.07.026

Zacny JP: A possible link between sensation-seeking status and positive subjective effects of oxycodone in healthy volunteers. Pharmacol Biochem Behav. 2010; 95(1): 113-120. DOI: 10.1016/j.pbb.2009.12.015. DOI: https://doi.org/10.1016/j.pbb.2009.12.015

Martin WR, Sloan JW, Sapira JD, et al.: Physiologic, subjective, and behavioral effects of amphetamine, methamphetamine, ephedrine, phenmetrazine, and methylphenidate in man. Clin Pharma Therap. 1971; 12(2): 245-258. DOI: 10.1002/cpt-1971122part1245. DOI: https://doi.org/10.1002/cpt1971122part1245

Sharma A, Minh Duc NT, Luu Lam Thang T, et al.: A consensus-based checklist for reporting of survey studies (CROSS). J Gen Intern Med. 2021; 36(10): 3179-3187. DOI: 10.1007/s11606-021-06737-1. DOI: https://doi.org/10.1007/s11606-021-06737-1

Angst MS, Phillips NG, Drover DR, et al.: Pain sensitivity and opioid analgesia: A pharmacogenomic twin study. Pain. 2012; 153(7): 1397-1409. DOI: 10.1016/j.pain.2012.02.022. DOI: https://doi.org/10.1016/j.pain.2012.02.022

Kawasaki S, Francis E, Mills S, et al.: Multi-model implementation of evidence-based care in the treatment of opioid use disorder in Pennsylvania. J Subst Abuse Treat. 2019; 106: 58-64. DOI: 10.1016/j.jsat.2019.08.016. DOI: https://doi.org/10.1016/j.jsat.2019.08.016

O'Brien BC, Harris IB, Beckman TJ, et al.: Standards for reporting qualitative research: A synthesis of recommendations. Acad Med. 2014; 89(9): 1245-1251. DOI: 10.1097/ACM.0000000000000388. DOI: https://doi.org/10.1097/ACM.0000000000000388

Oliverio A, Castellano C: Experience modifies morphine-induced behavioral excitation of mice. Nature. 1974; 252(5480): 229-230. DOI: 10.1038/252229a0. DOI: https://doi.org/10.1038/252229a0

Murphy NP, Lam HA, Maidment NT: A comparison of morphine-induced locomotor activity and mesolimbic dopamine release in C57BL6, 129Sv and DBA2 mice. J Neurochem. 2001; 79(3): 626-635. DOI: 10.1046/j.1471-4159.2001.00599.x. DOI: https://doi.org/10.1046/j.1471-4159.2001.00599.x

Cicero TJ, Ellis MS, Surratt HL, et al.: The changing face of heroin use in the United States: A retrospective analysis of the past 50 years. JAMA Psychiatry. 2014; 71(7): 821-826. DOI: 10.1001/jamapsychiatry.2014.366. DOI: https://doi.org/10.1001/jamapsychiatry.2014.366