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Prescription Opioid Misuse Index in sickle cell patients: A brief questionnaire to assess at-risk for opioid abuse

Wally R. Smith, MD, Donna K. McClish, PhD, John D. Roberts, MD, Osama Kandalaft, MD, Bassam Dahman, PhD, Janet Knisely, PhD, James Levenson, MD, Susan Roseff, MD, Imo P. Aisiku, MD


Objective: To develop a survey instrument to identify adult sickle cell disease (SCD) patients on chronic opioid therapy who are at-risk for opioid abuse.

Design: Prospective survey and interview.

Setting: Adult SCD clinic in a large urban teaching facility.

Patients/participants: Convenience sampling of adult patients presenting to the sickle cell clinic.

Interventions: None.

Main outcome: Primary outcome was “at-risk for opioid misuse,” defined as at least 3/8 “yes” answers (a positive composite score) on the Prescription Opioid Misuse Index (POMI) questionnaire. Secondary outcome was DSM-IV criteria for substance abuse using the DSM IV Diagnostic Interview Schedule.

Results: Of the 99 patients who completed the POMI, the mean age was 36 years; 58.6 percent were female, 48 percent were hemoglobin SS (47/99), and 26 percent were SC (26/99). Twenty-four percent (24/99) were identified as at-risk for opioid misuse using the POMI. There were no differences in demographic, SCD genotype, or socioeconomic variables for at-risk versus not-at-risk patients.

Conclusion: Twenty-four percent of unselected adult SCD patients on opioids were identified as at-risk for opioid misuse using a quick survey. This may represent as much as 2.5-7 times the national misuse rate. This group of patients may benefit from additional diagnostic and therapeutic interventions to help understand and manage their opioid usage.


sickle cell, opioid, addiction, pain, survey, abuse

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