Background. Community pharmacies rely on Prescription Monitoring Programs (PMP) to identify opioid-related risk. A validated PMP-based opioid-risk algorithm does not exist. The PharmScreen study (CTN-0093; NCT03936985) was designed to independently validate the Narcotic Score, a PMP risk metric (NS Metric), developed/deployed by the largest US PMP vendor (42/50 states) as a universal screen.
Design. A one-group, cross-sectional, web-based health assessment. Setting. Within 19 pharmacies from a large US chain, patients picking-up opioid medications were offered study information. Assessments. Self-report assessments included: demographics; the WHO Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST); Short Form-12 (for general health); and Brief Pain Inventory. The PMP vendor provided participants' NS metric scores. Analyses. With the ASSIST as the gold-standard: machine learning determined optimal NS Metric risk thresholds; Receiver Operating Characteristic curves and Spearman (P) and Kappa (K) coefficients analyzed concurrent validity. Regression analyses evaluated participant characteristics associated with NS Metric misclassification.
Participants. A total of 1,464 individuals completed the assessment. Participants were on average ~49 years old (SD=14.9), primarily White (92.5%), and female (61.9%). The NS metric showed fair concurrent validity (Area Under the Curve≥0.70; K=0.35; P=0.37, p<0.001). The ASSIST and NS metric categorized 36.9% of participants as low-risk (i.e., not needing screening/intervention) and 32.2% as moderate/high-risk (i.e., needing screening/intervention). Further, 17.1% were categorized as moderate/high NS metric risk but low ASSIST risk-these participants reported disability (OR=3.12), poor general health (OR=0.66), and/or greater pain severity/interference (OR=1.12/1.09; all p<0.05)-with 85.5% reporting current moderate/high pain (i.e., needing unmanaged-pain screening/intervention). Finally, 13.7% were categorized as moderate/high ASSIST risk but low NS metric risk-these participants reported greater overdose history (OR=1.24) and/or illicit substance use (OR=1.81-12.66; all p<0.05).
Discussion. While possibly not a strong identifier of non-opioid substance use, the NS metric could serve as a universal prescription opioid-risk screener given its: low burden relative to other "quick-screens" (i.e., no direct patient assessment); high accuracy in identifying low-risk patients and those needing opioid use/unmanaged pain screening/intervention; and broad US availability.