Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

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    Patent Pending

    Opioid Risk Tool (ORT) for Narcotic Abuse

    Estimates risk of opioid-related aberrant behaviors.
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    INSTRUCTIONS

    This tool studied patients at a chronic pain clinic.
    When to Use
    Why 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.

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • 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.

    Formula

    Addition of the selected points. Complete scoring information can be found in the derivation study.

    Facts & Figures

    Score interpretation:

    • Low risk: 0–3
    • Moderate risk: 4–7
    • High risk: ≥ 8

    Other Notes:

    • 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:

    • Used additional opioids than those prescribed
    • Requested refills instead of clinic visit
    • Canceled clinic visit
    • Solicited opioids from other providers
    • Unauthorized ER visits
    Dr. Lynn Webster

    About the Creator

    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