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Cross-Validation of a Screener to Predict Opioid Misuse in Chronic Pain Patients (SOAPP-R)

Butler, Stephen F. PhD; Budman, Simon H. PhD; Fernandez, Kathrine C. MPH; Fanciullo, Gilbert J. MD; Jamison, Robert N. PhD

Journal of Addiction Medicine: June 2009 - Volume 3 - Issue 2 - p 66-73
doi: 10.1097/ADM.0b013e31818e41da
Original Article

Objectives: The Screener and Opioid Assessment for Patients with Pain—Revised (SOAPP-R) is a self-report questionnaire designed to predict aberrant medication-related behaviors among persons with chronic pain. This measure was developed to complement current risk assessment practices and to improve a clinician's ability to assess a patient's risk for opioid misuse. The aim of this study was to cross-validate the SOAPP-R with a new sample of chronic, noncancer pain patients.

Methods: Three hundred two participants (N = 302) prescribed opioids for pain were recruited from 5 pain management centers in the U.S. Subjects completed a series of self-report measures and were followed for 5 months. Patients were rated by their treating physician, had a urine toxicology screen, and were classified on the Aberrant Drug Behavior index.

Results: Seventy-three percent (73.2%) of the subjects (N= 221) were followed and 66 participants repeated the SOAPP-R after 1 week for test-retest reliability. The reliability and predictive validity, as measured by the area under the curve (AUC), were found to be highly significant (test-retest reliability = 0.91; coefficient α = 0.86; AUC = 0.74) and were sufficiently similar to values found with the initial sample. A cut-off score of 18 revealed a sensitivity of 0.80 and specificity of 0.52.

Conclusions: Results of this cross-validation study suggest that the psychometric parameters of the SOAPP-R are not based solely on the unique characteristics of the initial validation sample. The SOAPP-R is found to be a reliable and valid screening tool for risk of aberrant drug-related behavior among chronic pain patients.

From the Inflexxion, Inc. (SFB, SHB, KCF), Newton, MA; Department of Anesthesiology (GJF), Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Departments of Anesthesia and Psychiatry (RNJ), Pain Management Center, Brigham & Women's Hospital, Boston, MA.

Received for publication June 30, 2008; accepted September 17, 2008.

Send correspondence and reprint requests to Stephen Butler, PhD, 320 Needham Street, Suite 100, Newton, MA 02464-1594. e-mail:

Supported, in part, by grant no. DA015617 from the National Institutes of Health, Bethesda, MD to SFB and by an unrestricted grant to Inflexxion, Inc. from Endo Pharmaceuticals, Chadds Ford, PA.

© 2009 American Society of Addiction Medicine