Opioid drugs are excellent analgesics for acute and chronic pain patients but have significant risks. For decades, opioid-treated patients have become addicted to these painkillers, leading to drug abuse, overdoses, and even death.
That’s why healthcare providers use an opioid risk tool (ORT) to assess the likelihood of this happening before starting patients on opioid therapy.
In this article, we’ll dive into how opioid risk tools work, the questions you need to answer to get results, and more.
What Is an Opioid Risk Tool (ORT)?
An opioid risk tool is a small questionnaire-like report that is used to assess risk for opioid abuse. Healthcare providers use opioid risk tools in different primary care settings before prescribing opioids for pain relief.
Opioid risk tools ask several questions that explore different risk factors linked to aberrant drug-related behavior. ORTs don’t determine drug abuse for certain, but they are highly accurate.
For example, adult patients with a family history of opioid use disorder (OUD) or a personal history of drug abuse are often in the high-risk category. This doesn’t mean they can’t be prescribed opioids, but they should be closely monitored to minimize the risk of addiction.
How Do Opioid Risk Tools Work?
First, you choose your gender, and then you answer ten yes/no questions.
Each answer gives you a score from zero to five; at the end of the ORT, the score is added up. Your score corresponds to a risk category (low, moderate, or high).
Opioid Risk Tool Questions
Opioid risk tools contain ten questions or risk assessments considering your demographics, personal history, and family history. All “yes” answers give a score of zero to five, while all “no” don’t change your score whatsoever.
Here are the questions you can expect.
- Sex (Male or Female): This is the only question that doesn’t require a yes/no answer and doesn’t give a score.
- Age Between 16-45 Years: If yes, +1
Family History of Substance Abuse
- Alcohol: If yes, +0
- Illegal Drugs: If yes, +0
- Prescription Drugs: If yes, +4
Personal History of Substance Abuse
- Alcohol: If yes, +3
- Illegal Drugs: If yes, +4
- Prescription Drugs: If yes, +5
Personal History of Sexual Abuse
- Preadolescent Sexual Abuse: If yes, +0
Personal History of Psychological Disease
- ADD, OCD, Bipolar, Schizophrenia: If yes, +2
- Depression: If yes, +1
Opioid Risk Tool Scores
After adding the numbers from the questions above, your score should range from zero to 26. Based on your score, you’ll be categorized into one of the following three risk categories:
- Low-Risk Category: Scores 0-3
- Moderate-Risk Category: Scores 4-7
- High-Risk Category: Score 8+
Interpreting Opioid Risk Tool Results
ORT results are an excellent screening tool, but physicians can ignore them if the benefits of opioid therapy outweigh the risks.
For example, a doctor might prescribe opioid pain medicine despite a moderate or high-risk potential for cancer patients. However, they’ll still monitor chronic pain patients and look for signs of potential addiction.
It’s worth noting that having a personal history of prescription drug abuse gives the highest score of all the questions. That alone gives you five points, which puts you in the moderate-risk category and more than halfway to high-risk.
In this case, doctors usually refrain from prescribing opioids, regardless of your ORT score, to avoid relapse. Instead, they might prescribe non-opioid painkillers such as paracetamol, ibuprofen, and aspirin.
How Accurate Are ORTs?
ORT results don’t provide conclusive evidence, but they can help healthcare providers conduct a risk-benefit analysis before prescribing opioids.
Studies mentioned in Future Medicine’s Pain Management Volume 11 have explored the accuracy of ORTs as risk assessment tools.
These studies were conducted on patients who were given an ORT, prescribed opioid drugs, and then monitored for aberrant behavior. A few of these behaviors included things like:
- Using more opioids than prescribed (once or more than once)
- Forging prescriptions
- Feeling euphoria with opioids
- Craving opioids and feeling anxious without them
- Overdose or death
After monitoring these patients for months, the study gave each risk category a percentage of likelihood for drug abuse. The percentages were as follows:
- Low-Risk Category: 5.6%
- Moderate-Risk Category: 28%
- High-Risk Category: 91%
Opioid Risk Tool Limitations
The main problem with opioid risk tools is their reliance on self-reported information. Some patients might not be honest while answering their assessment. Others might forget or not know the answers to the questions, especially for elderly patients.
Another problem with opioid risk tools is that they don’t encompass all the factors contributing to addiction. For example, they don’t consider patients’ social environments, previous traumas, comorbid medical conditions, or access to healthcare.
Combining ORT and Other Risk Tools
While opioid risk tools can be used alone, they’re often combined with other risk assessment tools to make more accurate predictions. Some of these tools include:
- Screener and Opioid Assessment for Patients with Pain (SOAAP)
- Screening Instrument for Substance Abuse Potential (SISAP)
- Diagnosis, Intractability, Risk, and Efficacy Score (DIRE)
After individuals prescribed opioids have started therapy, other assessment tools can replace the ORT and offer more accuracy, such as:
- Prescription Drug Use Questionnaire-patient (PDUQ-p)
- Current Opioid Misuse Measure (COMM)
- Pain Medication Questionnaire (PMQ)
- Pain Assessment and Documentation Tool (PADT)
- Addiction Behavior Checklist (ABC)
Opioid risk tools are like weather forecasts, letting healthcare providers know they might run into stormy waters up ahead. But remember, ORTs only predict your potential for opioid addiction, so whether or not you develop a substance abuse problem is not certain.