Detecting Problematic Opioid Use in the Electronic Health Record: Automation of the Addiction Behaviors Checklist in a Chronic Pain Population

IMPORTANCE: Individuals whose chronic pain is managed with opioids are at high risk of developing an opioid use disorder. Large data sets, such as electronic health records, are required for conducting studies that assist with identification and management of problematic opioid use. OBJECTIVE: Determine whether regular expressions, a highly interpretable natural language processing technique, could automate a validated clinical tool (Addiction Behaviors Checklist(1)) to expedite the identification of problematic opioid use in the electronic health record. DESIGN: This cross-sectional study reports on a retrospective cohort with data analyzed from 2021 through 2023. The approach was evaluated against a blinded, manually reviewed holdout test set of 100 patients. SETTING: The study used data from Vanderbilt University Medical Center’s Synthetic Derivative, a de-identified version of the electronic health record for research purposes. PARTICIPANTS: This cohort comprised 8,063 individuals with chronic pain. Chronic pain was defined by International Classification of Disease codes occurring on at least two different days.(18) We collected demographic, billing code, and free-text notes from patients’ electronic health records. MAIN OUTCOMES AND MEASURES: The primary outcome was the evaluation of the automated method in identifying patients demonstrating problematic opioid use and its comparison to opioid use disorder diagnostic codes. We evaluated the methods with F1 scores and areas under the curve - indicators of sensitivity, specificity, and positive and negative predictive value. RESULTS: The cohort comprised 8,063 individuals with chronic pain (mean [SD] age at earliest chronic pain diagnosis, 56.2 [16.3] years; 5081 [63.0%] females; 2982 [37.0%] male patients; 76 [1.0%] Asian, 1336 [16.6%] Black, 56 [1.0%] other, 30 [0.4%] unknown race patients, and 6499 [80.6%] White; 135 [1.7%] Hispanic/Latino, 7898 [98.0%] Non-Hispanic/Latino, and 30 [0.4%] unknown ethnicity patients). The automated approach identified individuals with problematic opioid use that were missed by diagnostic codes and outperformed diagnostic codes in F1 scores (0.74 vs. 0.08) and areas under the curve (0.82 vs 0.52). CONCLUSIONS AND RELEVANCE: This automated data extraction technique can facilitate earlier identification of people at-risk for, and suffering from, problematic opioid use, and create new opportunities for studying long-term sequelae of opioid pain management.