Using Screening Tests to Predict Aberrant Use of Opioids in Chronic Pain Patients: Caveat Emptor

Screening tests represent a critical tool in chronic pain treatment for predicting aberrant opioid use, which has emerged as a significant public health issue. Nevertheless, there remains a significant potential for the misapplication of screeners in this context. The potential difficulties in evaluating the diagnostic efficiency of screeners have been well established, particularly with regard to the effect that the prevalence of a disorder has on predictive value. The wide range in the reported prevalence of aberrant opioid use behaviors makes it difficult to interpret data obtained from popular screeners for assessing the potential for the aberrant use of opioids. Given the prevalence of opioid problems, however, formulating clear clinical guidelines on such screeners appears highly important. The aims of the present report include: 1) providing a review of the salient issues necessary for interpreting diagnostic efficiency statistics of screening tests, 2) identifying the critical differences between sensitivity, specificity, and predictive value, and 3) discussing the characteristic effects that disease prevalence has on statistical prediction. The article also reviews key processes in screening measure development and highlights several key considerations relevant to their appropriate use in clinical decision-making. Perspective This article highlights common metrics for evaluating the clinical utility of screening tests in predicting aberrant opioid use. In addition, it explores a series of considerations key to developing clinical guidelines for interpreting the results of screeners in this context.