Glossary – HARMS

BPI = Brief Pain Inventory
The BPI is a validated tool that measures a patient’s pain and functional impairment. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory.Ann Acad Med Singapore 23(2): 129-138, 1994). Find out more here: https://www.mdanderson.org/research/departments-labs-institutes/departments-divisions/symptom-research/symptom-assessment-tools/brief-pain-inventory.html and find a copy here: http://nationalpaincentre.mcmaster.ca/documents/brief_pain_inventory.pdf

BPI = Brief Pain Inventory

The BPI is a validated tool that measures a patient’s pain and functional impairment. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory.Ann Acad Med Singapore 23(2): 129-138, 1994). Find out more here:
https://www.mdanderson.org/research/departments-labs-institutes/departments-divisions/symptom-research/symptom-assessment-tools/brief-pain-inventory.html and find a copy here:
http://nationalpaincentre.mcmaster.ca/documents/brief_pain_inventory.pdf

CNCP = Chronic non-cancer pain (generally also means “non-palliative” pain)
HARMS was built for UDT in this population. Patients with cancer and/or palliative pain are typically excluded. Chronic pain is typically defined as >90 days or past the time of normal healing.

COMM = Current Opioid Misuse Measure
A self-report screener that detects problematic opioid-related behaviours in patients with pain who are receiving opioid therapy. Stacey A McCaffrey, Ryan A Black, Albert J Villapiano, Robert N Jamison, Stephen F Butler, Development of a Brief Version of the Current Opioid Misuse Measure (COMM): The COMM-9, Pain Medicine, Volume 20, Issue 1, January 2019, Pages 113–118, https://doi.org/10.1093/pm/pnx311. Learn more about it here: https://ibhsolutions.com/blog/questions-comm-9-answered/

COMM = Current Opioid Misuse Measure

A self-report screener that detects problematic opioid-related behaviours in patients with pain who are receiving opioid therapy. Stacey A McCaffrey, Ryan A Black, Albert J Villapiano, Robert N Jamison, Stephen F Butler, Development of a Brief Version of the Current Opioid Misuse Measure (COMM): The COMM-9, Pain Medicine, Volume 20, Issue 1, January 2019, Pages 113–118, https://doi.org/10.1093/pm/pnx311. Learn more about it here:
https://ibhsolutions.com/blog/questions-comm-9-answered/

DIRE = Diagnosis, Intractability, Risk, and Efficacy Score
The DIRE is a clinician-rated instrument designed for use by primary care physicians to predict the efficacy of analgesia and adherence with long-term opioid therapy. The DIRE score can range from 7 to 21, with a score of 13 or below suggesting that a patient is not a suitable candidate for long-term opioid therapy. Belgrade MJ, Schamber CD, Lindgren BR. The DIRE score: predicting outcomes of opioid prescribing for chronic pain. J Pain. 2006;7(9):671-681. You can find the DIRE tool here: http://www.emergingsolutionsinpain.com/content/tools/esp_9_instruments/pdf/DIRE_Score.pdf

DIRE = Diagnosis, Intractability, Risk, and Efficacy Score

The DIRE is a clinician-rated instrument designed for use by primary care physicians to predict the efficacy of analgesia and adherence with long-term opioid therapy. The DIRE score can range from 7 to 21, with a score of 13 or below suggesting that a patient is not a suitable candidate for long-term opioid therapy. Belgrade MJ, Schamber CD, Lindgren BR. The DIRE score: predicting outcomes of opioid prescribing for chronic pain. J Pain. 2006;7(9):671-681. You can find the DIRE tool here:
http://www.emergingsolutionsinpain.com/content/tools/esp_9_instruments/pdf/DIRE_Score.pdf

GC-MS/MS = Gas chromatography tandem mass spectrometry
This is an older variation of LC-MS/MS which many laboratories still use for their drug confirmatory testing today. Laboratories are switching to LC-MS/MS when possible due to the newer test’s ability to analyze more compounds at once and the process is much less labour intensive.

HARMS = High-yield Approach to Risk Mitigation and Safety
HARMS is a clinic-wide system built to support routine urine drug testing in clinical medicine. There are specific innovations within the HARMS Program that aim to address previous barriers to UDT in clinical medicine (START-IT Tool, Risk Ladder, general program structure that delegates to non-medical staff, and others). HARMS has won awards at the provincial and national levels for innovation and scalability.

HARMS = High-yield Approach to Risk Mitigation and Safety

HARMS is a clinic-wide system built to support routine urine drug testing in clinical medicine. There are specific innovations within the HARMS Program that aim to address previous barriers to UDT in clinical medicine (START-IT Tool, Risk Ladder, general program structure that delegates to non-medical staff, and others). HARMS has won awards at the provincial and national levels for innovation and scalability.

IA = Immunoassay
Also sometimes called “Point-of-care”, or “presumptive testing”, this is the method of UDT that is applied in the office (although lab can also do it). Urine is collected and “dipped” using the kit. Results are available within minutes, and the test is relatively inexpensive (we pay $4.50 for each standard 5-panel test). Unfortunately it is generally less sensitive and less specific than LC-MS. There are panels available commercially for numerous drugs with varying sensitivities and specificities.

IA = Immunoassay

Also sometimes called “Point-of-care”, or “presumptive testing”, this is the method of UDT that is applied in the office (although lab can also do it). Urine is collected and “dipped” using the kit. Results are available within minutes, and the test is relatively inexpensive (we pay $4.50 for each standard 5-panel test). Unfortunately it is generally less sensitive and less specific than LC-MS. There are panels available commercially for numerous drugs with varying sensitivities and specificities.

LC-MS/MS = Liquid chromatography tandem mass spectrometry
Also sometimes called “confirmatory testing”, this is done by the lab. While it takes 1-2 weeks for results, it has a very important role because it’s specificity is theoretically 100% (assuming no human error in documentation or sample mix-up). It also checks for >100 drugs (exact drugs will vary depending on the lab).

OAT = Opioid agonist treatment
There are numerous other terms (Opioid substitution therapy, opioid maintenance therapy, etc.) that refer to typically using either methadone or buprenorphine/naloxone prescribed in a controlled setting to treat opioid use disorder by addressing opioid withdrawal and cravings. 2018 Canadian guidelines (CRISM) specifically recommend buprenorphine/naloxone as the first-line treatment for opioid use disorder.

OAT = Opioid agonist treatment

There are numerous other terms (Opioid substitution therapy, opioid maintenance therapy, etc.) that refer to typically using either methadone or buprenorphine/naloxone prescribed in a controlled setting to treat opioid use disorder by addressing opioid withdrawal and cravings. 2018 Canadian guidelines (CRISM) specifically recommend buprenorphine/naloxone as the first-line treatment for opioid use disorder.

ORT = Opioid Risk Tool
The ORT is a validated tool that uses patient self-report to assess risk of developing opioid use disorder when prescribed opioids for chronic non-cancer pain. Questionnaire developed by Lynn R. Webster, MD to assess risk of opioid addiction. Webster LR, Webster R. Predicting aberrant behaviors in Opioid‐treated patients: preliminary validation of the Opioid risk tool. Pain Med. 2005; 6 (6) : 432). Find it here: https://www.drugabuse.gov/sites/default/files/files/OpioidRiskTool.pdf

ORT = Opioid Risk Tool

The ORT is a validated tool that uses patient self-report to assess risk of developing opioid use disorder when prescribed opioids for chronic non-cancer pain. Questionnaire developed by Lynn R. Webster, MD to assess risk of opioid addiction. Webster LR, Webster R. Predicting aberrant behaviors in Opioid‐treated patients: preliminary validation of the Opioid risk tool. Pain Med. 2005; 6 (6) : 432). Find it here:
https://www.drugabuse.gov/sites/default/files/files/OpioidRiskTool.pdf

OUD = Opioid use disorder
Colloquially known as opioid addiction, and in previous versions of the Diagnostics and Statistics Manual (DSM) called Opioid abuse or opioid dependence. There are 11 specific criteria and depending on how many criteria are met it may be mild, moderate or severe.

SOAPP-R/ SOAPP-8 = Screener for Opioid Assessment for Patients with Pain – Revised
SOAPP-R is used to risk stratify patients prescribed opioids for CNCP for future problematic behaviours. (Ryan A Black, Stacey A McCaffrey, Albert J Villapiano, Robert N Jamison, Stephen F Butler, Development and Validation of an Eight-Item Brief Form of the SOAPP-R (SOAPP-8), Pain Medicine, Volume 19, Issue 10, October 2018, Pages 1982–1987, https://doi.org/10.1093/pm/pnx194). Learn more about it here https://ibhsolutions.com/blog/questions-soapp-8/

SOAPP-R/ SOAPP-8 = Screener for Opioid Assessment for Patients with Pain – Revised

SOAPP-R is used to risk stratify patients prescribed opioids for CNCP for future problematic behaviours. (Ryan A Black, Stacey A McCaffrey, Albert J Villapiano, Robert N Jamison, Stephen F Butler, Development and Validation of an Eight-Item Brief Form of the SOAPP-R (SOAPP-8), Pain Medicine, Volume 19, Issue 10, October 2018, Pages 1982–1987, https://doi.org/10.1093/pm/pnx194). Learn more about it here
https://ibhsolutions.com/blog/questions-soapp-8/

START-IT = Self-report, Testing and Automated Reading Tool for Immunoassay Tests
START-IT is a national-award winning IT tool that is typically applied using a tablet PC by non-medical staff at the clinic. It aims to greatly simplify the entire UDT process at the clinic through the collection of all the required information for UDT result interpretation: prescribed medication and last dose, self-reported non-prescribed drugs and last use, and immunoassay test results themselves. Results are then interpreted within the limitations of the test (false positives, false negatives) and clinically-relevant explanations are given about what the result means. If using the OCEAN platform, then report syncs with most Ontario EMRs with the click of a button. We have never had any monetary gain from START-IT, always offering it for free (however if using the OCEAN platform – completely unaffiliated – then they have a monthly subscription fee).

START-IT = Self-report, Testing and Automated Reading Tool for Immunoassay Tests

START-IT is a national-award winning IT tool that is typically applied using a tablet PC by non-medical staff at the clinic. It aims to greatly simplify the entire UDT process at the clinic through the collection of all the required information for UDT result interpretation: prescribed medication and last dose, self-reported non-prescribed drugs and last use, and immunoassay test results themselves. Results are then interpreted within the limitations of the test (false positives, false negatives) and clinically-relevant explanations are given about what the result means. If using the OCEAN platform, then report syncs with most Ontario EMRs with the click of a button. We have never had any monetary gain from START-IT, always offering it for free (however if using the OCEAN platform – completely unaffiliated – then they have a monthly subscription fee).

UDT
Urine drug testing.

UrIntepret
A smartphone application we designed to give rapid and comprehensive UDT interpretation, including IA and LC-MS. The application also includes the START-IT tool and high-yield interactive Clinical Cases.