Curated insights • How it Works • Practical Pearls • Evidence Base
CLINICAL INSIGHT
When to Use
When to Use
Used continuously to monitor patients already actively receiving extended opioid therapy for non-cancer pain.
Unlike the ORT (which predicts future risk before prescribing), the COMM detects concurrent misuse, abuse, or psychological distress resulting from therapy.
CLINICAL INSIGHT
How it Works
Core Assessment Domains
Signs and Symptoms of Intoxication (e.g., trouble thinking clearly).
Emotional Volatility (e.g., arguments, anger).
Evidence of Prescription Violation (e.g., early clinic visits, taking medications belonging to others).
A high COMM score may simply indicate severe, poorly controlled pain driving desperation (pseudoadaddiction) or underlying poorly managed psychosocial comorbidities, rather than outright substance use disorder.
Do NOT use the COMM as punitive evidence to abruptly terminate a patient. It is a trigger for deeper clinical conversation.
CLINICAL INSIGHT
Next Steps
Management
< 9: Current aberrant behaviors are unlikely. Continue protocol.
≥ 9: High risk for current misuse. Action needed: Order a urine drug screen (UDT), check the state Prescription Drug Monitoring Program (PDMP), request a pill count, and evaluate for hyperalgesia or psychological crisis.
COMM
Please answer each question honestly based on how you have been feeling over the past 30 days.
