MDCalc

Revised Opioid Risk Tool (ORT-OUD)

Measures risk of opioid drug abuse in patients with chronic pain.

  • This revision of the Opioid Risk Tool removes the preadolescent sexual abuse item and all sex-based weighting on the basis of new evidence.
  • Please see Evidence for more information.

Age 16-45

History of depression

History of ADD, OCD, bipolar disorder, or schizophrenia

Personal history of alcohol abuse

Personal history of illegal drug abuse

Personal history of prescription drug abuse

Family history of alcohol abuse

Family history of illegal drug abuse

Family history of prescription drug abuse

Result:

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Advice
  • Exercise caution when starting any patient on chronic opiates.
  • A high score should prompt mitigation strategies, not automatic denial of analgesia.
Management

For all patients:

  • Educate on safe use, storage, disposal, and therapy risks.
  • Check the PMDP.
  • Obtain informed consent and complete a written opioid treatment agreement.
  • Schedule routine follow-up and periodic drug screens.

For high-risk patients (score ≥3):

  • Consider non-opioid or multimodal analgesia, when feasible.
  • If opioids are unavoidable, start at the lowest effective dose and shortest course possible.
  • Add safeguards, including: 
    • Naloxone co-prescription.
    • Mandatory in-person refills.
    • Pill counts.
    • More frequent follow-up.
  • Consider referral to pain management.
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