The SISAP: A new screening instrument for identifying potential opioid abusers in the management of chronic nonmalignant pain within general medical practice
RB Coambs | JL Jarry | AC Santhiapillai | RV Abrahamsohn | et al
Many physicians are overly cautious about prescribing
opioids for chronic pain because of fears of iatrogenic
addiction. However, in patients with chronic pain, addiction
to opioid analgesics is exceedingly rare when there
is no prior history of alcohol or drug abuse.
OBJECTIVE: To validate an instrument that separates
possible opioid abusers from those who are at low risk.
DESIGN/METHODS: The Screening Instrument for
Substance Abuse Potential (SISAP) was designed to identify
individuals with a possible substance abuse history
quickly and accurately. It is based on the National
Alcohol and Drug Use Survey (n=9915). Using the first
half of the sample (n=4967), two previously validated
alcohol use items were combined with three illicit drug
use items. These five questions identified those with
a history of alcohol and/or illicit drug use.
RESULTS: Using the second half of the sample
(n=4948), the validation procedure showed that the five
combined items correctly classified 91% of substance
abusers and had a low rate of false negatives.
DISCUSSION: The SISAP is brief and resistant
to misrepresentation or falsification. The SISAP is
expected to improve pain management by facilitating
focus on the appropriate use of opioid analgesics and
therapeutic outcomes in the majority of patients who
are not at risk of opioid abuse, while carefully monitoring
those who may be at greater risk.