(430) Performance of universal 5Ps screening to detect opioid use disorder on labor and delivery

Screening for opioid use disorder (OUD) in pregnancy should utilize a validated instrument. The 5Ps is a self-reported instrument assessing substance use in parents, peers, partners, past, and pregnancy. We aimed to describe rates of screening as well as test performance to identify OUD.


Study Design:

Universal 5Ps screening was implemented for all patients presenting to labor and delivery in January 2020. Data were extracted from electronic medical records from January 2020 through July 2025 for completion of 5Ps screening, responses to individual tool components, and presence OUD using a validated algorithm. Rates of 5Ps screening was stratified by year. To assess clinical utility of 5Ps, we calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) relative to presence of OUD. Receiver operating characteristic (ROC) curve and area under the curve (AUC) was calculated using SPSS to quantify overall test performance.


Results:

Of the 39,125 deliveries that occurred during the study period, 31,063 (79.4%) were screened with 5Ps. OUD was present in 189 (0.6%) of all screened pregnancies. A positive response to any 5Ps item had a sensitivity of 74.1% and NPV of 99.8%. A positive response to the “past” item demonstrated the highest single-item sensitive of 70.9% and NPV of 99.8%. The 5Ps demonstrated good discriminatory performance (AUC=0.86, 95% confidence interval: 0.82-0.89). The optimal cutoff threshold was ≥1 ‘yes’ response.


Conclusion:

Universal use of 5Ps on labor and delivery is an effective screening tool to identify OUD. Our analysis validate the clinical relevance of a positive response to any single item on the 5Ps screening tool as an indicator warranting further assessment for OUD.