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Opioid Risk Tool (ORT) for Narcotic Abuse
Estimates risk of opioid-related aberrant behaviors.
This tool studied patients at a chronic pain clinic.
When to Use
The ORT may help identify patients at high risk for misuse, and who who might benefit more from other modalities of pain control besides narcotics (primarily applicable to patients with chronic pain).
Substance use -- particularly of prescribed drugs -- has been an increasing problem in the United States. It is reasonable to consider risk of future abuse/diversion/misuse, especially if considering prescribing narcotics to high risk patients.
Pain medications should not be withheld for painful conditions simply because a patient is deemed “high risk” by the ORT, but these patients should be considered for other modalities of pain control if appropriate.
These high risk patients may be appropriate candidates for referral to pain management.
Providers should exercise caution when starting any patient on chronic opiates.
Addition of the selected points. Complete scoring information can be found in the derivation study.
Facts & Figures
Low risk: 0–3
Moderate risk: 4–7
High risk: ≥ 8
185 patients were followed in chronic pain clinic
Tracked to determine who developed "aberrant behaviors"
Developed a score based on this to calculate this risk
Of note, still 5% of "low-risk" patients still had aberrant behaviors.
Aberrant behaviors included a long list of behaviors indicating possible abuse, including but not limited to:
Lynn Webster, MD, is medical director at CRI Lifetree in Salt Lake City, Utah and is also the co-founder of LifeSource, a non-profit foundation providing education about pain-related issues. Dr. Webster has authored over 100 scientific abstracts and journal articles, and he recently published Avoiding Opioid Abuse While Managing Pain: A Guide for Practitioners. He has also received honoraria related to formal advisory activities and as a consultant from the American Academy of Pain Management, American Board of Pain Medicine, Boston Scientific Corporation, and multiple pharmaceutical companies.
To view Dr. Lynn Webster's publications, visit PubMed