UC Irvine

Opioid use, misuse, abuse and addiction is a growing epidemic in the United States. The purpose of this systematic review is to identify screening instruments used in emergency medicine (EM) settings to detect opioid drug use and to assess the psychometric data for each screening instrument. The review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, PsychINFO, Cochrane Database of Systematic Reviews, Web of Science, CENTRAL, CINAHL, CRD and ClinicalTrials.gov were searched for articles published up to June 2017. We extracted 172 articles for initial screening and 66 articles were assessed for eligibility. Ten articles were extracted from the full-text assessment. Eight instruments were identified from the finalized article list: SOAPP-R; ASSIST; two, single-item screening questions; one-item binge-drinking screener question; patient medical charts; medical history and physical/patient self-reporting in medical charts; Drug Abuse Screening Test; and HERA/SBIRT. Screening instrument characteristics, study characteristics, and reliability and validity data were extracted from the 10 studies. A meta-analysis was not conducted due to heterogeneity between the studies. There is a lack of validity and reliability evidence in all 10 articles; and sensitivity, specificity and predictive values varied between the different instruments. These instruments are not validated for use in EM settings. There is no clear evidence to state which screening instruments are appropriate for use in detecting opioid drug abuse in EM patients. There is a need for brief, reliable, valid and feasible screening instruments and more psychometric data.