Layton et al developed simple scores for evaluating patients starting a pain medication. This can be incorporated into a Modified Prescription-Event Monitoring (M-PEM) study. The authors are from the Drug Safety Research Unit at Bursledon Hall in Southampton, England.

Patient selection: patient starting a pain medication with abuse potential


Risk factors for dependence upon starting treatment:

(1) alcohol misuse

(2) smoker

(3) substance misuse

(4) psychiatric disorder

(5) opioid withdrawal syndrome during treatment


Risk factors for aberrant behaviors during treatment:

(1) overwhelming focus on opioid-related issues

(2) escalating drug use unexplained by change in clinical condition (early refills, etc)

(3) reports lost, spilled or stolen medication

(4) requests therapy from multiple prescribers

(5) unclear etiology of pain and/or exaggeration of pain

(6) accidental or unsanctioned diversion to a third party



• The first 4 items are based on the Chabal criteria for problematic opioid use.


Each risk factor is scored 0 if absent and 1 if present.



• minimum dependence score: 0

• maximum dependence score: 5

• minimum aberrant behaviors score: 0

• maximum aberrant behaviors score: 6

• The higher the scores the greater the risks associated with opiate or opioid pain medication.

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