Construct validity and reproducibility of the Prescription Opioid Misuse And Abuse Questionnaire (POMAQ)

Figures & data

Table 1. Participant-reported demographic and clinical characteristics.

Characteristic	Total	Test–retest stable sample
	(N = 809)	(N = 139)
Age, mean years ± SD	55.4 ± 12.7	53.7 ± 12.5
Range (min, max)	(20.0–88.0)	(20.0–81.0)
Gender, n (% female)	449 (55.5%)	81 (58.3%)
Ethnicity, n (%)
Not Hispanic or Latino	733 (90.6%)	6 (4.3%)
Hispanic or Latino	70 (8.7%)	133 (95.7%)
Missing	6 (0.7%)	0 (0.0%)
Race, n (%)
White or Caucasian	605 (74.8%)	111 (79.9%)
Other	93 (11.5%)	15 (10.8%)
Black or African American	84 (10.4%)	9 (6.5%)
American Indian or Alaska Native	10 (1.2%)	1 (0.7%)
Asian	9 (1.1%)	2 (1.4%)
Missing	6 (0.7%)	0 (0.0%)
Native Hawaiian or other Pacific Islander	2 (0.2%)	1 (0.7%)
Current pain condition (n, %)^a
Low back pain	620 (76.6%)	115 (82.7%)
Neck or shoulder pain	488 (60.3%)	84 (60.4%)
Osteoarthritis	313 (38.7%)	58 (41.7%)
Other neuropathic pain (nerve damage)	296 (36.6%)	52 (37.4%)
Migraine or other chronic headache	256 (31.6%)	39 (28.1%)
Other	224 (27.7%)	46 (33.1%)
Fibromyalgia	172 (21.3%)	31 (22.3%)
Post-operative pain	138 (17.1%)	21 (15.1%)
Rheumatoid arthritis	120 (14.8%)	18 (12.9%)
Central pain	111 (13.7%)	22 (15.8%)
Bone break or fracture	87 (10.8%)	22 (15.8%)
Painful diabetic neuropathy	78 (9.6%)	10 (7.2%)
Pain related to cancer	35 (4.3%)	6 (4.3%)
Phantom pain	29 (3.6%)	3 (2.2%)
Visceral pain	14 (1.7%)	3 (2.2%)
Post herpetic neuralgia	10 (1.2%)	2 (1.4%)
Missing	2 (0.2%)	0 (0.0%)
Sickle cell pain	1 (0.1%)	0 (0.0%)

Abbreviation. SD, standard deviation.

^aNot mutually exclusive.

Table 2. Construct validity of select questions on the POMAQ and PDUQp^a.

PDUQp item	POMAQ item		Percent agreement	PABAK
Q11: Have you had to increase the amount of pain medications you take over the past 6 months?	Q4. In past year…taken more prescription opioid pain medication than was prescribed?
	Yes (n = 156)	No (n = 627)
Yes (n = 202)	76 (9.7%)	126 (16.1%)	73.7%	0.474
No (n = 581)	80 (10.2%)	501 (64.0%)
Q12: Have you had to call in for more pain medications because your prescription ran out?	Q14. In past year…requested refills for prescription opioid pain medication earlier than they were due?
	Yes (n = 117)	No (n = 664)
Yes (n = 145)	56 (7.2%)	89 (11.4%)	80.8%	0.616
No (n = 636)	61 (7.8%)	575 (73.6%)
Q15. Do you ever use alcohol to help relieve some of the pain?	Q6. In past year…drink alcohol while taking prescription opioid pain medication?
	Yes (n = 229)	No (n = 556)
Yes (n = 81)	65 (8.3%)	16 (2.0%)	77.1%	0.541
No (n = 704)	164 (20.9%)	540 (68.8%)
Q17: Have you ever lost your pain medications and needed them replaced?	Q12. In past year… prescription opioid pain medication has been lost?
	Yes (n = 21)	No (n = 766)
Yes (n = 39)	17 (2.2%)	22 (2.8%)	96.7%	0.934
No (n = 748)	4 (0.5%)	744 (94.5%)
Q18: Have you had to visit the emergency room in the past 6 months because of your pain problem?	Q15. In past year… visited ER or Urgent Care clinic to get more prescription opioid pain medication?
	Yes (n = 29)	No (n = 758)
Yes (n = 109)	23 (2.9%)	86 (10.9%)	88.3%	0.766
No (n = 678)	6 (0.8%)	672 (85.4%)
Q19. Have you ever had to buy pain medications on the street?	Q8. In past year…got opioid pain medication from someone who was NOT a doctor or healthcare provider?
	Yes (n = 19)	No (n = 768)
Yes (n = 9)	4 (0.5%)	5 (0.6%)	97.5%	0.949
No (n = 778)	15 (1.9%)	763 (97.0%)

Abbreviations. PABAK, Prevalence-Adjusted Bias-Adjusted Kappa; PDUQp, Prescription Drug Use Questionnaire-patient version; POMAQ, Prescription Opioid Misuse and Abuse Questionnaire.

^aSample size based on patients who completed both PDUQp and POMAQ questions.

Table 3. Sensitivity and Specificity of Select Abuse/Dependence Items of the SCID-I Compared to the POMAQ^a.

SCID-I item	POMAQ item		Percent agreement	Sensitivity	Specificity
Current Alcohol Abuse or Dependence Evaluation	Q6. In past year… drank alcohol while taking prescription opioid pain medication?
	Yes (n = 6)	No (n = 436)
Yes (n = 7)	6 (1.4%)	1 (0.2%)	99.8%	85.7%	100.0%
No (n = 435)	0 (0.0%)	435 (98.4%)
Current Cannabis Abuse or Dependence Evaluation	Q9a. In past year, took prescription opioid pain medication with marijuana, hashish, or synthetic cannabis?
	Yes (n = 7)	No (n = 660)
Yes (n = 17)	7 (1.0%)	10 (1.5%)	98.5%	41.2%	100.0%
No (n = 650)	0 (0.0%)	650 (97.5%)
Current Prescription Opioid Abuse or Dependence Evaluation	In past year… Q4: took more than prescribed? Q5: tampered with medication? or Q8: got any opioid medication not prescribed to you?
	Yes (n = 5)	No (n = 587)
Yes (n = 5)	5 (0.8%)	0 (0.0%)	100.0%	100.0%	100.0%
No (n = 587)	0 (0.0%)	587 (99.2%)

Abbreviations. SCID-I, Structured Clinical Interview for DSM-IV-TR Axis I Disorders; POMAQ, Prescription opioid misuse and abuse questionnaire.

^aSample size based on patients who had current abuse or had no abuse based on the SCID-I evaluation.

Table 4. Summary of construct validity between POMAQ and urine and hair toxicity screens.

Metabolites	POMAQ item		Percent agreement	PABAK
Urine metabolites for anti-anxiety medications^a	Responses to Item Q7b^b
	Yes (n = 159)	No (n = 631)
Yes (n = 119)	81 (10.3%)	38 (4.8%)	85.3%	0.706
No (n = 671)	78 (9.9%)	593 (75.1%)
Urine metabolites for opioid medications take n < 12 h from urine collection^c	Responses to Item Q1^d
	Yes (n = 596)	No (n = 2)
Yes (n = 556)	554 (92.6%)	2 (0.3%)	92.6%	0.853
No (n = 42)	42 (7.0%)	0 (0.0%)
Hair metabolites for anti-anxiety medications^e	Responses to Item Q7b^b
	Yes (n = 83)	No (n = 302)
Yes (n = 32)	24 (6.2%)	8 (2.1%)	82.6%	0.652
No (n = 353)	59 (15.3%)	294 (76.4%)
Hair metabolites for opioid medications^f	Responses to Item Q1^d
	Yes (n = 384)	No (n = 1)
Yes (n = 319)	318 (82.6%)	1 (0.3%)	82.6%	0.652
No (n = 66)	66 (17.1%)	0 (0.0%)

Abbreviations. 6-MAM, 6-monoacetylmorphine; CI, confidence interval; PABAK, Prevalence-Adjusted, Bias-Adjusted Kappa; POMAQ, Prescription Opioid Misuse and Abuse Questionnaire.

^a7-aminoclonazepam, alpha-Hydroxyalprazolam, Lorazepam, Nordiazepam, Oxazepam, Temazepam, Alprazolam, 2-Hydroxy-ethyl-flurazepam, 7-Aminoflunitrazepam, Alpha-Hydroxy-Midazolam, Estazolam, Diazepam.

^bQ7b: In the past 3 months, did you take your prescription opioid pain medication with [response from Q7]? (Response: Anti-anxiety medications (e.g. benzodiazepines such as diazepam [Valium®], alprazolam [Xanax^®], clonazepam [Klonopin^®], lorazepam [Ativan^®]).

^cCodeine, Morphine, Hydrocodone, Hydromorphone, 6-MAM, Norhydrocodone, Oxycodone, Oxymorphone, Noroxycodone, Naloxone, Dextromethorphan, Tramadol, o-desmethyltramadol, Buprenorphine, Norbuprenorphine, Fentanyl, Norfentanyl, Methadone, EDDP.

^dQ1: In the past 3 months, what prescription opioid pain medications have you taken that were prescribed to you by your doctor or healthcare provider? Responses: Hydrocodone alone or in combination with another medication; Hydromorphone; Oxycodone alone or in combination with another medication; Methadone; Codeine alone or in combination with another medication; Oxymorphone; Morphine; Fentanyl (e.g. Duragesic, Fentora, Abstral, Actiq, Lazanda, Onsolis, Subsys); Buprenorphine (e.g. Butrans, Subutex, Suboxone, Zubsolv, Belbuca, Bunavail); Tramadol alone or in combination with another medication; Tapentadol (e.g. Nucynta, Nucynta ER); Other opioids.

^eAlprazolam, alpha-Hydroxyalprazolam, Clonazepam, Diazepam, Nordiazepam, Oxazepam, Temazepam, Midazolam, 7-Aminoclonazepam, Nitrazepam, Triazolam, Lorazepam, Flunitrazepam, 7-Aminoflunitrazepam.

^fCodeine, Morphine, 6-MAM, Hydrocodone, Norhydrocodone, Hydromorphone, Oxycodone, Noroxycodone, Oxymorphone, Ketamine, Norketamine, Fentanyl, Norfentanyl, Sufentanil, Norsufentanyl, Meperidine, Normeperidine, Methadone, EDDP, Tramadol, Buprenorphine, Norbuprenorphine.

Table 5. EMR data by POMAQ response.

EMR data point	POMAQ item
“HCP shopping” EMR data	Q10: In the past year…visited more than 1 doctor or healthcare provider to get more prescription opioid pain medication?
	Yes	No
	(N = 89)	(N = 720)
Mean # of visits to pain management, family physician, primary physician, or substance abuse clinics (SD)	6.1 (9.1)	5.2 (8.6)
Mean # of all HCP^a visits (SD)	28.1 (25.2)	24.9 (24.9)
“Pharmacy shopping” EMR data	Q11: In the past year…gone to more than 1 pharmacy to obtain prescription opioid pain medication?
	Yes (N = 215)	No (N = 594)
# of Pharmacy locations for new prescription opioid (mean, SD)	1.40 (0.50)	1.21 (0.43)
# of pharmacy location for opioid refill (mean, SD)	1.47 (0.53)	1.17 (0.39)
Patients with at least one refill from a different pharmacy (N [%])	98 (46%)	95 (16%)
Early prescription refill EMR data	Q14: In the past year…requested refills for prescription opioid pain medication earlier than they were due?
	Yes (N = 122)	No (N = 687)
# opioid refills in past 1 year (mean, SD)	14.9, 7.8	12.2, 7.2
Patients with at least one refill < 21 days from prior prescription (days’ supply > 21 days) (N [%])	56 (45.9%)	200 (29.2%)
Patients with 15 or more refills for an opioid (N [%])	10 (8.2%)	18 (2.6%)
ER/UR EMR data	Q15. In past year… visited ER or Urgent Care clinic to get more prescription opioid pain medication?
	Yes (N = 32)	No (N = 777)
# ER/UC clinic visits in past 1 year (mean, SD)	2.3 (2.3)	1.1 (2.7)

EMR, electronic medical record; ER, emergency room; HCP, healthcare provider; POMAQ, Prescription Opioid Misuse and Abuse Questionnaire; SD, standard deviation; UC, urgent care.

^aPain management, family physician, primary physician, substance abuse clinics. Internal medicine, mental health, neurology, oncology, orthopedic, paediatric, psychiatry, psychology, rehabilitation, specialty, unspecified, and others.