ASI-SR Form as a Standardized Instrument for Healthcare Management of Chronic Non-cancer Pain Patients

The use of opioids in treatment of chronic non- cancer pain (CNCP) has increased during the past decades in most parts of the western world. Use of prescription opioids can lead to problematic opioid use which can be life-threatening with significant morbidity and mortality. Studies have found that 21-29% of CNCP patients receiving chronic opioid therapy (COT) ( receiving opioids for > 90 days) have problematic opioid use. Individuals with chronic pain and co-occurring substance use disorders and/or mental health disorders, have increased risk for problematic use of prescribed opioids.

Several screening instruments and strategies have been introduced in recent years for identifying patients not suitable for opioid therapy. Even so, there is no single test or instrument that can reliably identify those patients at risk for developing problematic opioid use or opioid use disorder if opioid therapy is initiated, or identify those who need increased monitoring during treatment.

Addiction Severity Index (ASI) is a standardized semi-structured interview used for assessing severity and need of treatment in seven functional domains associated to substance use disorders; physical health, employment/support status, alcohol use, drug use, legal status, family/social functioning and psychiatric health. The ASI was developed in the US. by McLellan and colleagues and is widely used all over the world, both in research and for clinical assessment and treatment evaluations . The ASI could be a useful instrument for a multidimensional assessment of patients with chronic non-cancer where opioid treatment is considered, and it could also be used for evaluation of ongoing opioid therapy . However, the ASI interview is a time consuming instrument. To conduct an interview takes between 45-60 minutes and is followed by 20-25 minutes of administrative work. In the year of 2000 Rosen et al tested a short self-report form based the items used to calculate the ASI composite scores that asses current function and problem severity. This questionnaire was translated by our research group and tested on a sample of individuals referred to the Addiction clinic at Uppsala University Hospital. The study suggested that a self-administered questionnaire based on the subscales of the ASI composite scores is a feasible alternative to the ASI interview for assessing patient functioning in the different domains and screen for current problematic alcohol- or drug use .

A validated screening tool that provides both an effective method of assessing patients and identifying problems in several different life domains, and identify substance use related problems if they should arise, would be beneficial in clinical practice when deciding what treatment to offer. Such an instrument could potentially decrease the risk of iatrogenic opioid use disorder.

Purpose and aims The main objective with this study is to test the psychometric properties of the ASI-SR in a population of CNCP patients. 'Secondary aim is to describe differences between subjects treated within the substitution therapy program and those who are treated within the pain clinic.