Clinician Validation of Poison Control Center (PCC) Intentional Exposure Cases Involving Prescription Opioids

Abstract

Poison Control Center (PCC) cases involving intentional ingestion, injection or inhalation of prescription opioids are a potentially valuable source of information on the abuse and misuse of these products. This study sought to validate PCC classifications of prescription opioid intentional exposure cases against clinical diagnostic criteria. 4,321 cases were reviewed. PCC-clinician concordance was good to excellent for Withdrawal, Abuse, and Suicide (kappa statistics: 0.73, 0.53, 0.48, respectively), but poor for Misuse and Intentional Unknown (Specific motive not known). Interrater reliability among clinicians was good (weighted kappa range: 0.56–0.68). Results demonstrate the degree of compatibility between PCC and standard nosologic classifications.

Keywords:

• Abuse
• interrater reliability
• Poison Control Centers
• prescription opioids

Notes

¹The 8 centers reporting for the entire study period included: Rocky Mountain Poison and Drug Center, Cincinnati Drug and Poison Information Center, Northern New England Poison Center, California Poison Control System, Virginia Poison Center, Blue Ridge Poison Center, Florida Poison Information Center, Miami Division, Kentucky Regional Poison Control Center. The 7 centers that contributed data for the final two quarters of the study period included: Florida Poison Information Center, Jacksonville Division, West Virginia Poison Center, Wisconsin Poison Center, Middle Tennessee Poison Center, Indiana Poison Center, Louisiana Drug and Poison Information Center, Regional Poison Center & Prevention Serving Massachusetts and Rhode Island.

²The remaining 1.5% of cases within the Abuse/Dependence category were distributed as follows: Criterion A3 (i.e., Physician reports drug abuse or dependence, not clear DSM-IV-TR^TM criteria were met), n = 7; Criterion A4 (i.e., Product intentionally used to produce euphoria, euphoria occurred), n = 2; Criterion A5 (Product intentionally used to produce euphoria in combination with other drugs, euphoria occurred), n = 5.