What Is the Opioid Risk Tool?

The Opioid Risk Tool (ORT) was developed to assess the risk for substance abuse in adults who are prescribed opioids as a treatment for chronic non-cancer pain. The initial goal was to evaluate the potential good of opioids versus the potential risks. This would alert health care professionals as to who requires careful observation during opioid treatment. Higher scores result in closer monitoring during the treatment plan.

The questionnaire

The original Opioid Risk Tool consists of a quick and simple questionnaire that can be administered and scored in less than a minute. It is composed of 10 questions; three concerning family history of substance abuse, three regarding personal history of substance abuse, one pertaining to age, one referencing a history of preadolescent sexual abuse, and two questions about psychological diseases.

Scores of three or under indicate a low risk for future opioid abuse, scores of four to seven indicate moderate risk, and scores of eight or higher indicate a high risk. The estimated contribution of genetics to an individual’s susceptibility to opioid addiction is between 50 and 60 percent. Life experiences also play a role.

Recent revisions

Although the Opioid Risk Tool was originally a means to help ensure that those at a high risk for opioid abuse are carefully monitored, it has been used as a weapon to deny opioid prescriptions. Experiencing preadolescent sexual abuse has also been a cause to decline opioids as a treatment for chronic pain. Women who answer “yes” to this question receive 3 points; however, men who respond “yes” receive 0 points. The ORT was never intended to be utilized as a determining factor of who should or should not be prescribed opioids to treat chronic pain.

A background of sexual abuse should never be the only gauge to assess whether opioid therapy should be received. The ORT should not be used to justify denying appropriate pain therapy. In 2019, a revised Opioid Risk Tool was developed. The revised ORT eliminates the use of a woman’s sexual abuse as a risk factor.

Opioid guidelines

In March 2016, the Centers for Disease Control and Prevention (CDC) released guidelines for the treatment of chronic pain by primary care physicians in terms of the use of opioid medications in individuals over the age of 18. These guidelines are provided for primary care clinicians treating people with chronic pain. The intent is to improve communication regarding the risks versus the benefits of opioid use as a chronic pain treatment, while reducing the number of opioid overdoses and deaths. The CDC has also issued guidelines to taper off opioids.

Canada’s Opioid Prescribing Guidelines are used by clinicians to prescribe opioids to individuals, 18 years old or older, living with chronic non-cancer pain. The guideline provides assistance to Canadian clinicians who prescribe opioids for chronic non-cancer pain management or create policies regarding opioid prescriptions.