Opioid Risk Tool

Patients in primary care and beyond, who are prescribed opioids are at different degrees of risk of misuse and developing opioid addiction. By screening those patients, the prescription of opioids is streamlined and other treatment alternatives are sought to reduce the risks.

Opioid Risk Tool items

The opioid risk tool calculator measures certain types of risk factors (known in literature) to be associated with substance abuse:

■ Personal and family history of substance abuse;

■ Age;

■ History of preadolescent sexual abuse;

■ Certain psychological diseases.

The following table introduces the items in the opioid risk tool and their respective number of points awarded, differentiated by gender.

The screening tool can be used in the context of chronic pain management with the aim to decrease potential abuse or diversion cases.

In order to increase the accuracy of its prediction, the score focuses on family and personal history of substance abuse.

ORT interpretation

Given that each choice in the score carries a potential number of points, in the end, these are summed to provide the final ORT score. The associated risks are as follows:

This means that patients scoring 7 or below are less likely than those scoring 8 or above to take on a pattern of substance, drug related abuse.

The score does not provide any guidelines in regard to preventing opioid medication to the higher risk patients, this being left to clinical judgment. However, it is known that this group of high risk, requires attentive monitoring.

About the original study

The original cohort consisted of 185 patients that were treated in one pain clinic and were given the self-administered questionnaire.

The final scores, placed in three risk categories, from low to high, predict the risk for aberrant behaviours for 12 months after initial visit.

From the results of the study:

■ 4% of low risk patients (17 out of 18) have not displayed any aberrant behaviour;

■ 9% of high risk patients (40 out of 44) have displayed an aberrant behaviour.

The ORT has shown predictability and high sensitivity in the validation studies as well, with great discrimination between genders (0.82 for male, 0.85 for female) and between the extreme ends of the score range.

The criticism of the model is that it focuses only on chronic pain and has not been validated in conditions that require opioid therapy but not for pain related purposes.

Dr Lynn Webster is the medical director of CRI Lifetree and cofounder of LifeSource (non-profit foundation for pain-related education).

Other risk assessments and opioid scores

Other tools that are used in practice include the Diagnosis, Intractability, Risk, Efficacy (DIRE) or the Substance Abuse Potential (SISAP). The first focuses on long term opioid therapy abuse risks while the second consists of 5 items that enquire about personal substance abuse history.

The Clinical Opiate Withdrawal Scale (COWS) on the other hand, evaluates the severity of withdrawal symptoms after opiate use.

Original reference

Webster LR, Webster RM. (2005) Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool. Pain Med. 2005; 6(6):432-42.

Validation study

Jones T, Lookatch S, Grant P, McIntyre J, Moore T. Further validation of an opioid risk assessment tool: the Brief Risk Interview. J Opioid Manag. 2014; 10(5):353-64.

Other references

1. Jamison RN, Juliana Serraillier J, Michna E. Assessment and Treatment of Abuse Risk in Opioid Prescribing for Chronic Pain. Pain Res Treat. 2011; 2011: 941808.

2. Moore TM, Jones T, Browder JH, Daffron S, Passik SD. A comparison of common screening methods for predicting aberrant drug-related behavior among patients receiving opioids for chronic pain management. Pain Med. 2009; 10(8):1426-33.