Development and field testing of new tools to monitor and evaluate harms of continuing and discontinuing long-term opioid therapy

Healthcare providers lack brief tools to monitor a broad range of harms related to long-term opioid therapy (LTOT) and to assess whether opioid tapering may be risky or difficult to initiate. We developed and field-tested 2 integrated tools to support clinical decision making around opioid continuation and tapering: Screen to Evaluate and Treat (SET) 1 and 2. SET1 assesses whether LTOT may be harmful to continue, and SET2 assesses whether an opioid taper may be difficult or harmful to initiate. Tool development included literature reviews to identify candidate items, refinement of item pools, and field-testing. During field-testing, we surveyed a population with a past-year opioid prescription of ≥90 days (SET1; n = 499) and a second population receiving LTOT with documentation of a dosage reduction (SET2; n = 237). After item selection, SET1 included 9 yes/no items covering pain experience, side effects, functioning, aberrant opioid use, and concerns or desire to take less medication. SET2 included 10 yes/no items covering concerns about withdrawal symptoms, use of other substances, feelings of helplessness, thoughts of self-harm, and desire to reduce opioid use. In preliminary validation, both tools had high test-retest reliability and convergent validity for criterion outcomes related to the domains of LTOT harms (SET1) and potential risks related to an opioid taper (SET2). SET1 and SET2 can be incorporated into routine clinical care to identify and document when patients are experiencing harms related to LTOT or may have difficulty with an opioid taper, supporting patient-centered treatment planning and ongoing monitoring of patients prescribed LTOT.