First Response to Opioids Survey Tool (FROST): Pilot study of a brief screening tool to assess opioid use disorder risk

Objective: Early work suggests the type of subjective experiences upon first opioid use may predict opioid use disorder (OUD) risk. This study developed and pilot-tested a brief survey to evaluate the “first response” to opioids. Design: A cross-sectional survey research study. The survey was administered to a subsample for the second time to assess test–retest reliability. Setting: Outpatient. Participants: Convenience sample of adults treated for OUD at an opioid treatment program. Main outcome measures: A seven-question First Response to Opioids Survey Tool (FROST), developed based on the existing questionnaires and stakeholderadvisor feedback, was evaluated. Results: Participants (N = 157) were 36.8 (standard deviation [SD] = 9.4) years old, with 79.6 percent identifying as Caucasian and 56.7 percent male. They reported opioid initiation at 20.6 (SD = 8.8) years old, with a prescription-based (78.3 percent), orally administered (66.2 percent), and illicitly procured (51.0 percent) opioids. Upon opioid initiation, positive-valence, euphoria-like subjective experiences of feeling “comfortable” (65.0 percent), “happy” (61.1 percent), “euphoria” (58.6 percent), and “energized” (44.6 percent) were common, and different (p < 0.05) from other types of subjective experiences. Among 64 individuals who answered a question about “drug-liking,” 50 (78.1 percent) reported drug-liking. Among 31 respondents who completed the survey a second time, the test–retest consistency was 78.2 percent for subjective experience characteristics and 72 percent for drug-liking responses. Qualitative results corroborated quantitative findings. Conclusion: These results suggest that euphoria-type experiences and drug-liking upon opioid initiation are common among adults with OUD and FROST's promising psychometric properties. Future research should assess clinical utility of this brief survey, which could be applied at bedside and help identify those at risk for OUD, guide safer opioid prescribing, and reduce opioid-related harm.