COMM is a 17-item self-report measure designed to detect current aberrant opioid-related behaviour over the past 30 days in adults with chronic non-cancer pain already prescribed long-term opioids. It complements pre-treatment risk tools by focusing on ongoing behaviours during therapy rather than lifetime risk factors.

Key evidence

The original development and validation study enrolled 227 adults with chronic non-cancer pain from US hospital-based and private pain clinics who had been on opioid therapy (≥20 mg oxycodone equivalent per day) for more than 6 months. All participants completed the 40-item alpha COMM, an interview (Prescription Drug Use Questionnaire), urine toxicology, and a clinician-completed Prescription Opioid Therapy Questionnaire; these were combined into an aberrant drug-related behaviour index (ADBI) used as the reference standard for current misuse.

Study	Population	Outcome / criterion	AUC	Cut-off ≥9
Derivation / validation (Pain 2007)	227 chronic non-cancer pain patients on long-term opioids in pain clinics	Composite ADBI (interview, clinician ratings and urine toxicology)	≈0.81	Sensitivity 0.77, specificity 0.66 for detecting current aberrant use
3-month follow-up subset	86 of the original cohort reassessed	Change in ADBI status	≈0.92	Sensitivity 0.94, specificity 0.73; negative predictive value about 0.95
Cross-validation (Clin J Pain 2010)	Independent chronic pain cohort on opioid therapy	Aberrant medication-related behaviour	≈0.79	Performance similar to the original study using the same ≥9 cut-off

Later psychometric work, including Rasch analyses, shortened forms (for example COMM-9) and computer-adapted administration, has generally supported the COMM’s internal consistency and discriminative ability while exploring briefer versions for routine monitoring.

Limitations and use

Derived and validated predominantly in English-speaking adults attending specialist pain clinics; performance in primary care, perioperative, cancer or palliative populations is less certain.
Relies on self-report and a past-30-day timeframe; scores can be influenced by recall, stigma or misunderstanding of items and should be interpreted alongside clinical interview, prescription records and urine drug testing where available.
COMM is a screening tool for current aberrant opioid-related behaviour, not a diagnostic instrument for opioid use disorder and not a stand-alone reason to continue or stop opioid therapy.

Current Opioid Misuse Measure (COMM)