Current Opioid Misuse Measure (COMM)

Identifies potential medication misuse in patients who are on long-term opioid therapy.

Ask the patient: In the past 30 days…

How often have you had trouble with thinking clearly or had memory problems?

How often do people complain that you are not completing necessary tasks?

i.e., doing things that need to be done, such as going to class, work, or appointments

How often have you had to go to someone other than your prescribing physician to get sufficient pain relief from your medications?

i.e., another doctor, the Emergency Room

How often have you taken your medications differently from how they are prescribed?

How often have you seriously thought about hurting yourself?

How much of your time was spent thinking about opioid medications?

i.e., having enough, taking them, dosing schedule, etc.

How often have you been in an argument?

How often have you had trouble controlling your anger?

e.g., road rage, screaming, etc.

How often have you needed to take pain medications belonging to someone else?

How often have you been worried about how you're handling your medications?

How often have others been worried about how you're handling your medications?

How often have you had to make an emergency phone call or show up at the clinic without an appointment?

How often have you gotten angry with people?

How often have you had to take more of your medication than prescribed?

How often have you borrowed pain medication from someone else?

How often have you used your pain medicine for symptoms other than for pain?

e.g., to help you sleep, improve your mood, or relieve stress

How often have you had to visit the Emergency Room?

Result:

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Advice

Combine the use of this tool with other indicators of substance misuse, such as periodic urine drug screens.
The authors of the original study advise caution when interpreting results and recommend considering other extenuating circumstances.

Management

Scores ≥9:
- Evaluate the need for tapering opioids or exploring alternative pain management strategies.
- Provide or refer for behavioral health support, including addiction treatment if appropriate.
- If continuing opioid therapy, consider more frequent monitoring (e.g., urine drug testing, office visits).
Scores <9:
- Continue regular monitoring per standard care practices.
- Reinforce adherence to the treatment plan and educate the patient on opioid safety.
Document findings and any interventions to support care continuity.