Jan Klimas|Lauren Gorfinkel|Nadia Fairbairn|Laura Amato|Keith Ahamad|Seonaid Nolan|David L. Simel|Evan Wood
Strategies to Identify Patient Risks of Prescription Opioid Addiction When Initiating Opioids for Pain
University College Dublin|St. Paul's Hospital|University of British Columbia|British Columbia Centre on Substance Use|Columbia University|St. Paul's Hospital|University of British Columbia|British Columbia Centre on Substance Use|Agenzia Regionale Parchi|St. Paul's Hospital|University of British Columbia|British Columbia Centre on Substance Use|St. Paul's Hospital|University of British Columbia|British Columbia Centre on Substance Use|Durham VA Medical Center|Duke University|St. Paul's Hospital|University of British Columbia|British Columbia Centre on Substance Use
although prescription opioid use disorder associated substantial harms strategies identify patients pain among prescription opioids safely prescribed systematically reviewedto review evidence examining factors associated opioid addiction screening tools identifying adult patients high vs low risk developing symptoms prescription opioid addiction initiating prescription opioids painmedline embase january 1946 november 2018 searched articles investigating risks prescription opioid addictionoriginal studies included compared symptoms signs risk factors screening tools among patients developed prescription opioid addiction nottwo investigators independently assessed quality exclude biased unreliable study designs extracted data higher quality studies preferred reporting items systematic reviews metaanalyses diagnostic accuracy studies prismadta reporting guideline followedlikelihood ratios lrs risk factors screening tools calculatedof 1287 identified studies 6 highquality studies included qualitative synthesis 4 included quantitative synthesis 4 highquality studies included quantitative synthesis retrospective studies including total 2 888 346 patients 4470 cases met authors definitions prescription opioid addiction history opioid use disorder lr range 1722 substance use disorder lr range 4217 certain mental health diagnoses eg personality disorder lr 27 95 ci 1841 concomitant prescription certain psychiatric medications eg atypical antipsychotics lr 17 95 ci 1518 appeared useful identifying patients high risk opioid addiction among individual findings absence mood disorder negative lr 050 95 ci 045052 associated lower risk opioid addiction despite widespread use screening tools involving combinations questions based lowquality studies diagnostic performance assessed among highquality studies demonstrated poor performance helping identify patients high vs low riskwhile history substance use disorder certain mental health diagnoses concomitant prescription certain psychiatric medications appeared useful identifying patients higher risk quality studies available symptoms signs screening tools particularly useful identifying lower risk