What is the Opioid Risk Tool?

What is the Opioid Risk Tool?

The ORT is a self-reported five-question questionnaire that helps doctors assess a person’s risk of developing OUD. Lynn Webster and Rebecca Webster developed the tool in 2005 based on a review of medical literature and on the authors’ personal experiences.

This tool is one of several optionsTrusted Source that doctors may use to assess the risk of addiction when prescribing opioids. More recently developed tools include:

• Brief Risk Interview (BRI)
• Brief Risk Questionnaire (BRQ)
• Current Opioid Misuse Measure (COMM)
• Patient Medication Questionnaire (PMQ)

The ORT uses known risk factors for opioid use to assess individual risk.

How does the Opioid Risk Tool work?

A doctor will use the ORT to assess the risk of OUD before prescribing pain medication for chronic, noncancerous conditions. The questionnaire has 5 questionsTrusted Source with a total of 10 factors, and a person will assign a score to each factor.

Each factor has a different weighting, and the original tool assigned different scores to male and female participants for some questions. When showing the maximum scores for sex differences below, the first number is the female score, while the second is the male score.

The factors and their maximum scores are as follows:

• a family history of substance abuse: alcohol (1 or 3), illegal drugs (2 or 3), or prescription drugs (4)
• a personal history of substance abuse: alcohol (3), illegal drugs (4), or prescription drugs (5)
• age range of 16 to 45 years (1)
• a history of preadolescent sexual abuse (3 or 0)
• a personal history of psychological disease: attention deficit hyperactivity disorder (ADHD) (2), obsessive-compulsive disorder (OCD) (2), bipolar disorder (2), schizophrenia (2), or depression (1)

The doctor then adds the scores in a person’s responses to create a risk score, which implies the following:

• 3 or lower: The person has a low risk of OUD.
• 4 to 7: The person has a moderate risk of OUD.
• 8 or higher: The person has a high risk of OUD.

Opioid Risk Tool example

The ORT may vary slightly depending on a person’s sex. For a female participant, the tool takes the following form:

Benefits of the Opioid Risk Tool

The ORT may be effectiveTrusted Source for screening people who are at low risk of OUD, and it can be helpful in clinics with a high volume of patients because it’s easier to use than other tools. For example, the COMM has 17 questionsTrusted Source, and the PMQ has 26. Administering and scoring the ORT can take less than a minute.

The test’s wide availabilityTrusted Source may be a benefit. For example, the ORT is available in smartphone apps such as MDCalc, meaning that doctors can readily access it for quick assessments.

A 2017 review found that the ORT did not accurately predict OUD-related behaviors when assessed alongside blood test results and clinical assessments. However, no risk assessment tool availableTrusted Source has a perfect rate of prediction. Also, people with chronic pain can develop OUD even if they have no risk factors at allTrusted Source.

The ORT remains significant because it allows doctors to provide other pain relief options to people who may have a high OUD risk, enabling care while reducing the risk of other health problems.

Drawbacks of the Opioid Risk Tool

The ORT can be helpful. However, according to a 2019 essay, it may not be beneficial if a doctor uses the ORT alone to assess the risk of opioid misuse or addiction.

The essay’s authors maintain that the main drawback of any opioid risk assessment tool is a reliance on self-reporting. People who are looking to access opioids may misrepresent histories or behaviors in a way that significantly shifts the risk score in their favor.

A reliable test has high sensitivity and specificityTrusted Source. “Sensitivity” means the test can accurately diagnose the risk or presence of a disease. “Specificity” means the test can identify those who do not have the disease or risk of a disease. In their original 2005 study of the ORT, Webster and Webster found that the tool had a sensitivity of 91% and a specificity of 94%.

The authors of the 2019 essay cited more recent studies, which have shown that the ORT has lower ranges of sensitivity (18% to 75%) and specificity (54% to 88%) than the original study authors found.

The authors of another 2019 studyTrusted Source proposed a revised ORT that removed the sex-based weighting on the preadolescent sexual abuse score. They found that version to be more effective at predicting potential opioid misuse than the original ORT.

The Centers for Disease Control and Prevention (CDC) has stated that limited evidence is availableTrusted Source to work out the clinical usefulness of opioid risk assessment tools. However, some pain relief prescription guidelines recommend them, and doctors still use them to help prevent OUD.

How to prevent opioid use disorder

Preventing OUD requires a person to use and store opioids safely and work on a treatment plan with their doctor.

The CDC advisesTrusted Source:

• never using more than the prescribed amount of an opioid or taking it more often than a doctor recommends
• not sharing or selling prescription opioids
• keeping opioids safely out of reach of children, friends, family, and visitors
• disposing of unused opioids through a drug take-back program or a pharmacy mail-back program or by flushing them down the toilet if they appear on the FDA’s Flush ListTrusted Source
• working with the prescribing doctor to make a plan that addresses pain relief expectations and the benefits and risks of opioid use
• discussing other pain relief options with a doctor
• being open and honest about personal and family medical history, especially around substance use disorders
• following up with the prescribing doctor within a few days of starting opioid use

Treatment for opioid use disorder

Treatment options for OUD will depend on a person’s needs and circumstances. Several forms of treatment are available. Treatment may vary in setting and duration.

Medications for OUD can be highly effective. The FDA has approved methadone, buprenorphine, and naltrexone to treat OUD. While the decision to take these medications is highly personal, strong evidence supports their use.

Outpatient counseling or a stay at an inpatient rehabilitation facility may be an option for some people and may provide additional benefits.

Support groups and family counseling can help people with OUD feel more connected and build life skills. Some organizations also provide support with finding employment, housing, or transportation.

Summary

The Opioid Risk Tool is one of many questionnaires that doctors may use to assess a person’s risk of opioid use disorder (OUD) before prescribing pain relief medications for noncancerous conditions. It involves 5 questions with 10 scorable factors and assigns an overall score that suggests a person may have a low, moderate, or high risk of developing OUD.

Some of the factors are weighted according to a person’s sex. However, more recent research has suggested that removing the weighting, particularly from the score for preadolescent sexual abuse, may allow for more accurate prediction.

The tool is widely available and quick and easy to use, but it relies on self-reporting, which may not always be accurate. Additionally, it may have lower sensitivity and specificity than the doctors who developed it found in their original study.