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Development of a brief tool for monitoring aberrant behaviours among patients receiving long-term opioid therapy: The Opioid-Related Behaviours In Treatment (ORBIT) scale


Larance, B and Bruno, R and Lintzeris, N and Degenhardt, L and Black, E and Brown, A and Nielsen, S and Dunlop, A and Holland, R and Cohen, M and Mattick, RP, Development of a brief tool for monitoring aberrant behaviours among patients receiving long-term opioid therapy: The Opioid-Related Behaviours In Treatment (ORBIT) scale, Drug and Alcohol Dependence, 159 pp. 42-52. ISSN 0376-8716 (2016) [Refereed Article]

Copyright Statement

Copyright 2015 Elsevier Ireland Ltd.

DOI: doi:10.1016/j.drugalcdep.2015.11.026


Background: Early identification of problems is essential in minimising the unintended consequences of opioid therapy. This study aimed to develop a brief scale that identifies and quantifies recent aberrant behaviour among diverse patient populations receiving long-term opioid treatment.

Method: 40 scale items were generated via literature review and expert panel (N  19) and tested in surveys of: (i) N = 41 key experts, and (ii) N  426 patients prescribed opioids >3 months (222 pain patients and 204 opioid substitution therapy (OST) patients). We employed item and scale psychometrics (exploratory factor analyses, confirmatory factor analyses and item-response theory statistics) to refine items to a brief scale.

Results: Following removal of problematic items (poor retest-reliability or wording, semantic redundancy, differential item functioning, collinearity or rarity) iterative factor analytic procedures identified a 10-item unifactorial scale with good model fit in the total sample (N = 426; CFI = 0.981, TLI = 0.975, RMSEA = 0.057), and among pain (CFI = 0.969, TLI = 0.960, RMSEA = 0.062) and OST subgroups (CFI = 0.989, TFI = 0.986, RMSEA = 0.051). The 10 items provided good discrimination between groups, demonstrated acceptable test–retest reliability (ICC 0.80, 95% CI 0.60–0.89; Cronbach's alpha = 0.89), were moderately correlated with related constructs, including opioid dependence (SDS), depression and stress (DASS subscales) and Social Relationships and Environment domains of the WHO-QoL, and had strong face validity among advising clinicians.

Conclusions: The Opioid-Related Behaviours In Treatment (ORBIT) scale is brief, reliable and validated for use in diverse patient groups receiving opioids. The ORBIT has potential applications as a checklist to prompt clinical discussions and as a tool to quantify aberrant behaviour and assess change over time.

Item Details

Item Type:Refereed Article
Keywords:opioid misuse, chronic pain, opioid analgesics, opioid substitution therapy, addiction, medication non-adherencea
Research Division:Psychology
Research Group:Other psychology
Research Field:Other psychology not elsewhere classified
Objective Division:Health
Objective Group:Public health (excl. specific population health)
Objective Field:Public health (excl. specific population health) not elsewhere classified
UTAS Author:Bruno, R (Associate Professor Raimondo Bruno)
ID Code:106558
Year Published:2016
Web of Science® Times Cited:21
Deposited By:Psychology
Deposited On:2016-02-13
Last Modified:2018-03-21

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