What is the SOAPP-8?
Broadly defined, the SOAPP-8 is a clinical tool used to determine a patient’s level of risk of misusing their opiate medication and the level of monitoring a patient on long-term opioid therapy may require. It was developed based on expert consensus regarding qualities likely to predict a patient’s risk of displaying aberrant medication-related behaviors.Now with only eight questions, the SOAPP-8 is a computer-based questionnaire which is part of the electronic assessment system, PainCAS, and is scored using an electronic algorithm.
What are the differences between the original SOAPP, the SOAPP-R, and the SOAPP-8?
The SOAPP-8 is the most recent and shortest version of the SOAPP. The SOAPP-8 retains as few questions as possible from its widely-used predecessors, the SOAPP and the SOAPP-R, while maximizing its predictive accuracy. The questions used in the SOAPP-8 and SOAPP-R are more subtle than those used in the SOAPP, which leaves less room for a patient to speculate the outcome of their answers and possibly manipulate to reflect their desired outcome.
Why were the SOAPP and SOAPP-8 created?
The SOAPP was created to help physicians identify patients who are at moderate or high levels of risk for problematic opioid-related behavior and would require closer monitoring. Physicians are increasingly reluctant to prescribe opioids in a time when aberrant opioid-related behavior is a common and widely publicized issue. The SOAPP-8 gives physicians a higher level of confidence in determining appropriate treatment options for chronic pain patients.
How can I determine whether a patient should be evaluated using the SOAPP-8?
The SOAPP-8 is intended to evaluate chronic pain patients being considered for opioid therapy.
Who should administer the SOAPP-8?
The SOAPP-8 is intended for clinician use and is administered to a patient as an electronic self-assessment.
Why the need for a shortened version of the SOAPP?
The length of the SOAPP-R may limit its utility in settings in which efficiency is critical. Examples of such settings include busy practices and emergency departments. The SOAPP-8 reduced the length of the SOAPP-R by 66% (from 24 items to 8).
How should the information from the SOAPP-8 be used?
Information gathered from the results of the SOAPP-8 can help clinicians determine the course of action for individual patients regarding opioid therapy plans with a greater level of confidence.
How accurate is the SOAPP-8 in determining at-risk patients and how worried should I be about at-risk patients falsely obtaining results that put them in a “not at risk” category?
Although the SOAPP-8 is a validated and highly accurate assessment, results from the SOAPP-8 should not stand alone in determining whether a patient is at risk for aberrant opioid-related behavior. In general, results from the SOAPP-8 are highly accurate and is more likely to present false positives than false negatives. It is possible for patients to manipulate the outcome of their questionnaire by choosing answers that they believe will produce a score that indicates they are “low risk” resulting in a false negative outcome. Questions on the SOAPP-8 do limit the risk of such manipulation occurring, but it is impossible to eliminate this risk with a self-report questionnaire.
What is recommended for those who score in the “high risk” range for the SOAPP-8?
Physicians should use their own discretion when deciding how to proceed with at-risk patients, but specific considerations for clinicians with patients who fall into this category includes:
- Obtain the patient’s past medical records
- Keep in contact with the patient’s previous and current providers
- Tell the patient that they will be expected to give a urine sample for toxicology screening at each initial clinic visit
- Establish time-based limitations on medication supplies
- Consider less abusable formulations of medications
- Change a patient’s treatment plan if they show early signs of aberrant behavior or violate their opioid agreement
What is recommended for those who score in the “moderate risk” range for the SOAPP-8?
Physicians can take the following considerations for patients who score in the “moderate risk” range:
- Administer urine screenings periodically
- The frequency of required clinic visits should depend on whether or not the patient displays aberrant behavior
- Monitor for violations of the opioid agreement. Violations of the opioid agreement warrant the need for professional assistance with the possibility for tapering or discontinuing opioid therapy
What is recommended for those who score in the “low risk” range for the SOAPP-8?
Patients who score in the low risk range should be able to handle their medication safely with a lower risk of aberrant opioid-related behavior potential. Providers should be aware of the potential of an at-risk patient falsely receiving a low score and should note any inconsistencies between the outcome of the assessment and the patient’s history and behaviors. The risk should be monitored on an on-going basis using the COMM-9 (Current Opioid Misuse Measure), the counterpart to the SOAPP-8.