The Current Opioid Misuse Measure (COMM) is a validated measure that has been computerized to reduce length and improve efficiency.
The COMM is a self-report instrument for identifying and monitoring opioid misuse in chronic pain patients taking prescription opioids for pain. The original COMM had 17 items that were empirically selected from a pool generated by pain management and addiction specialists. The COMM is intended to identify patients engaging in opioid abuse, opioid diversion, and opioid-seeking behaviors. Patients who score a 9 or above screen positive for opioid misuse. The COMM has been well-validated as a paper-and-pencil instrument. Researchers are adapting the COMM to be delivered via computer using a brief version of the COMM or using analytic methods to reduce the length of the COMM, based on the likelihood of a patient screening positive or negative.
Prescription opioid misuse
Young Adults (18-30)
Pain Management Clinics
Shortening the Current Opioid Misuse Measure via computer-based testing: A retrospective proof-of-concept study
Summary: Researchers used data from 415 non-cancer pain patients currently taking opioids who had participated in the validation and cross-validation studies of the full-length COMM to evaluate curtailed (i.e., ending the assessment when a respondent is certain to achieve a positive or negative result) and stochastically curtailed (i.e., ending the assessment when a respondent is sufficiently likely to achieve a positive or negative result, based on a predetermined criterion) versions of the COMM. Participants completed the full-length COMM (17 items) and the Aberrant Drug Behavior Index (ABDI). Researchers compared results of ABDI, the full-length COMM, the curtailed COMM, and the stochastically curtailed COMM with stopping criteria of 90%, 95%, and 99% (SC-90, SC-95, SC-99, respectively). Researchers used a sample of 214 respondents to train a model for stopping stochastically curtailed versions of the COMM. Psychometric testing was conducted with a final sample of 201 respondents. The full-length COMM, curtailed COMM, and SC-99 produced identical results, with a sensitivity of .70 and specificity of .70 for predicting the ADBI. SC-95 had sensitivity and specificity of .98 and 1.00, respectively, for predicting the full COMM and of .70 and .72, respectively, for predicting the ADBI. SC-90 had sensitivity and specificity of .97 and .99, respectively, for predicting the COMM, and .69 and .71 for predicting the ADBI. The average test lengths for the curtailed COMM, SC-99, SC-95, and SC-90 were 13.3, 10.7, 8.7, and 7 items, respectively. Assessments were stopped early for 71.6%, 88.1%, 90%, and 96.5% of respondents on the curtailed COMM, SC-99, SC-95, and SC-90, respectively.
Take Away: Shortening the COMM using curtailment and stochastic curtailment produced psychometrics identical or very similar to the full-length COMM, and produced good psychometrics for predicting the ADBI.
Summary: Researchers developed and validated a 9-item COMM using data from 517 non-cancer pain patients currently taking prescription opioids who participated in 3 prior studies using the full-length COMM on paper. Participants completed the full length COMM and the Aberrant Drug Behavior Index (ADBI). Researchers used statistical methods to select 9 items from the full-length COMM based on their accuracy for correctly screening patients, with items weighted differentially towards the final score. Researchers planned for the COMM-9 to be administered and scored by a computer, with the score indicating the probability that participants would screen positive on the ADBI. Researchers identified cut-offs for classifying patients as having no/low-, moderate-, and high-risk opioid use. Researchers evaluated the ability of the COMM-9 to correctly identify cases of opioid abuse (criterion validity) using receiver operator characteristic (ROC) curves. Data from a sample of 55 participants from the initial COMM validation study who completed the COMM a second time 1 week after the first administration were used to evaluate test-retest reliability. Participants with greater than a 50% chance of aberrant opioid-related behavior were classified as having a high-risk for aberrant opioid-related behavior with a sensitivity of .47 and specificity of .89. The COMM-9 had an internal consistency of .82, which was comparable to the internal consistency of the full-length COMM (.86). The area under the curve in ROC analyses was at least 0.77, which is considered fair.
Take Away: The COMM can be shortened to 9 items to be delivered and scored electronically while still maintaining similar psychometrics to the full-length COMM.