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The Prescribed Opioids Difficulties Scale: A Patient-centered Assessment of Problems and Concerns

Banta-Green, Caleb J. PhD, MPH, MSW*; Von Korff, Michael ScD; Sullivan, Mark D. MD, PhD‡ §; Merrill, Joseph O. MD, MPH§; Doyle, Suzanne R. PhD*; Saunders, Kathleen JD

doi: 10.1097/AJP.0b013e3181e103d9
Original Articles

Objectives Chronic opioid therapy for chronic noncancer pain has increased dramatically in recent years. Research on associated risks has typically focused on opioid abuse and dependence, and opioid misuse or aberrant drug use behaviors, but these risks have been defined from the providers' perspective. The aim of this article was to develop a psychometrically sound method for assessing difficulties patients attribute to chronic opioid therapy.

Methods A cross-sectional, observational study of patients prescribed opioids for chronic noncancer pain was conducted in a large integrated service delivery network in Washington State. Data were obtained from a phone interview and electronic health records including pharmacy data. Exploratory and confirmatory factor analyses were conducted using a split sample design.

Results The interview response rate was 56.5% and a total of 1144 patients were included in analyses. A 2 factor solution was obtained and replicated with excellent fit statistics. Two correlated factors were identified—opioid control concerns and psychosocial problems—with 50% of the sample reporting difficulties with prescribed opioids: 24% reported elevated psychosocial problems and 36% reported elevated concerns about controlling their use of prescribed opioids.

Discussion The Prescribed Opioid Difficulties Scale identifies common difficulties that patients ascribe to chronic opioid therapy. This scale may provide both an entry point and a framework for a patient-centered clinical dialog about the pros and cons of use of opioid medicines for managing chronic pain.

*Alcohol and Drug Abuse Institute

Departments of Psychiatry and Behavioral Sciences, School of Medicine

§Medicine, School of Medicine, University of Washington

Group Health Research Institute, Group Health, Seattle, WA

Supported by a grant from the National Institute on Drug Abuse Bethesda, Maryland, to Michael Von Korff (DA022557). Disclosure of interests: Dr. Von Korff has a grant pending from Johnson & Johnson. Dr. Sullivan has received grant support from Wyeth, Lilly, Aetna, Johnson & Johnson, and Ortho McNeil and has been a consultant for Eli Lilly.

Reprints: Caleb J. Banta-Green, PhD, MPH, MSW, Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St, Suite 120, Seattle, WA 98105 (e-mail:

Received for publication September 15, 2009; revised November 19, 2009; accepted February 1, 2010

© 2010 Lippincott Williams & Wilkins, Inc.