What is the most accurate way to screen for opiate addiction in patients on legitimate chronic opiate therapy?
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At present, not many screening tools are available with proven ability to help the clinician. The Screener and Opioid Assessment for Patients in Pain (SOAPP) can help identify patients on chronic narcotics who have aberrant drug-related behaviors (ADRBs), although the likelihood ratio for a positive test is small. (SOR B, based on validating cohort studies.) Further, the link between ADRBs and narcotic addiction is not robust. Pill counts and urine drug screening have not been convincingly shown to identify ADRBs. (SOR B, based on a systematic review of primarily lower quality studies.)
Evidence Based Practice 13(4): 06-07.