An emerging body of literature from the United States (US) describes ‘aberrant’ (i.e. divergent) medication-related behaviours among pain patients, and the extent to which they are associated with harm, including medical morbidity, dependence and diversion. To date, these clinical tools have not been validated in Australian clinical populations. This study seeks to address these issues through the development of an opioid-related behaviour scale designed for use in Australia. The purpose of the scale is to assist in the identification of behaviours relating to pharmaceutical opioids that may reflect problems with treatment so that clinicians can better assist patients to minimise any unintended consequences and harms (such as inadequate pain relief, overdose, accidents, dependence).
An emerging body of literature from the United States (US) describes ‘aberrant’ (i.e. divergent) medication-related behaviours among pain patients, and the extent to which they are associated with harm, including medical morbidity, dependence and diversion. To date, these clinical tools have not been validated in Australian clinical populations. This study seeks to address these issues through the development of an opioid-related behaviour scale designed for use in Australia. The purpose of the scale is to assist in the identification of behaviours relating to pharmaceutical opioids that may reflect problems with treatment so that clinicians can better assist patients to minimise any unintended consequences and harms (such as inadequate pain relief, overdose, accidents, dependence).
This study sought to (i) review the aberrant drug behaviour literature and (ii) describe the development of an aberrant drug behaviour scale for use in multiple healthcare settings in Australia. These studies were undertaken to inform the development and validation of a brief assessment tool to help clinicians stratify risks (in terms of severity and likelihood of harm). The behavioural indicators examineded included those associated with medication (non)adherence (taking prescribed doses at specified dosing intervals, via intended route of administration, under specified levels of supervision) and programmatic (non)adherence (attendance at dosing/review appointments, doctor shopping, diversion, etc).
In the first stage of the study, key experts (KEs) were surveyed regarding divergent opioid-related behaviours in terms of clinical relevance; frequency and severity of harm associated with the behaviour(s); and potential responses. Nationwide representation was sought from pharmacies, allied health, mental health, general practice, opioid substitution treatment, pain treatment, research and consumer representatives.
Information gathered from KEs, the literature and a project advisory committee informed the development of a patient survey. In this, the second stage of the study, the latent structure of the proposed scale, its construct validity and (inter-rater, test-retest) reliability were examined using interview data from chronic opioid treatment patients from OST clinics, pain clinics, general practice and pharmacy settings. A brief scale was then created using classical and modern test theory approaches.
A sub-sample was interviewed within a week of baseline interviews to establish test-retest and inter-rater reliability.
- Conducted literature review
- Obtained expert input into the design and content of the scale based on the literature, advisory committee input (including the project investigators) and Key Expert surveys (n=41). A total of 40 items on ‘aberrant’ and related opioid behaviours were included.
- Survey completed by n=427 chronic (3 months or longer) opioid participants; n=205 from OST treatment settings and n=222 who were primarily in treatment for pain
- Conducted n=42 retest surveys
- Shortlisted 10 items for consideration in the final scale based on statistical analyses and input from advisory committee, titled Opioid Related Behaviours In Treatment (ORBIT)
- Peer-reviewed manuscripts currently being prepared (January 2013).
Publications
Nielsen, S., Degenhardt, L., Larance, B., Black, E., Lintzeris, N., Ali, R., Cohen, M., Dunlop, A., Bruno, R., Rivas, G., Brown, A., Holland, R. (in press) Pain prevalence, severity and interference in an Australian opioid substitution therapy sample. Drug and Alcohol Review.
Scott-Smith, S., Larance, B., Shand, F., Degenhardt, L., Black, E., Nielsen, S. (2012). Prevalence and correlates of opioid-related behaviours among adults receiving long-term opioid therapy. Forensic Psychology masters dissertation.
Presentations
Nielsen, S., Larance, B., Black, E., Lintzeris, N., Degenhardt, L., Ali, R., Cohen, M., Dunlop, A., Bruno, R., Rivas, G., and Brown, A. (2012). Pain prevalence, severity and interference in an Australian opioid agonist treatment sample. Presented at the Australian Professional Society on Alcohol and Other Drugs (APSAD) Conference, Melbourne, 18-21 November.
Black, E. and Larance, B. (2012). Opioid-Related Behaviours In Treatment: The ORBIT Scale. Meeting of the Minds Seminar Series, Langton Centre, Sydney, 23 October.
Mattick. R.P., Larance, B., Bruno, R., Black, E., Lintzeris, N., Degenhardt, L., Nielsen, S., Murnion, B., Cohen, M., Ali, R., Dunlop, A. and Holland, R. (2012). Minimizing The Unintended Consequences Of Opioid Treatment: Development Of A Drug Behavior Scale For Use In Australia. The College on Problems of Drug Dependence (CPDD) Conference. Palm Springs, CA, USA, 9-14 June.
Black, E., Larance, B., Mattick, R., Lintzeris, N., Degenhardt, L., Bruno, R., Nielsen, S., Murnion, B., Cohen, M., Ali, R., Dunlop, A., Holland, R. (2011). Minimising The Unintended Consequences Of Opioid Treatment: Development Of A Drug Behaviour Scale For Use In Australia. Presented at the Australian Professional Society on Alcohol and Other Drugs (APSAD) Conference, Hobart, 13-16 November.
Black, E., Cohen, M., Murnion, B., Larance, B., Lintzeris, N., Degenhardt, L., Mattick, R.P. (2011). Minimising The Unintended Consequences Of Opioid Treatment: Development Of An Australian Aberrant Drug Behaviour Scale. Poster presented at The Frontiers of Pain: Australian Pain Society 31st Annual Scientific Meeting. Darwin, 12-16 June.
Black, E., Cohen, M., Murnion, B., Larance, B., Lintzeris, N., Degenhardt, L., Mattick, R.P. (2011). Minimising The Unintended Consequences Of Opioid Treatment: Development Of An Australian Aberrant Drug Behaviour Scale. Poster presented at the National Drug and Alcohol Research Centre (NDARC) Annual Symposium, Sydney, 30 August.
Several presentations to service providers. Audiences include the Hunter Integrated Pain Service (HIPS), Newcastle; and the Pain Clinic at Prince of Wales Hospital, Randwick.