Predicting Aberrant Behaviors in Opioid-Treated Patients: Preliminary Validation of the Opioid Risk Tool

Webster, Lynn R.; Webster, Rebecca M.

doi:10.1111/j.1526-4637.2005.00072.x

Cited by 938 publications

(634 citation statements)

References 56 publications

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“…This is a diagnostic dilemma, because the patient is able to legally fill a prescription, instead of having to use illegal channels. De novo iatrogenic addiction is found to occur in 0-50 % of COT patients, while aberrant/ problematic behaviors are common at ∼20 %, which is more likely the figure for substance use disorder [5]. Rates are always higher for patients with a past history of addiction.…”

Section: Chronic Pain and Opioid Therapymentioning

confidence: 99%

Chronic Pain, Chronic Opioid Addiction: a Complex Nexus

Salsitz

2015

J. Med. Toxicol.

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Over the past two decades, there has been a significant increase in the prescribing of opioids, with associated increases in opioid addiction and overdose deaths. This article reviews the evidence for the effectiveness and risk of developing an opioid use disorder (OUD) in those patients treated with chronic opioid therapy (COT) for chronic non-cancer pain (CNCP). Rates of development of OUD range from 0-50 %, and aberrant drug related behaviors (ADRBs) are reported to be 20 %. Health care providers must properly assess, screen, and carefully monitor patients on COT utilizing evidence-based tools.

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Section: Chronic Pain and Opioid Therapymentioning

confidence: 99%

Chronic Pain, Chronic Opioid Addiction: a Complex Nexus

Salsitz

2015

J. Med. Toxicol.

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“…One of the more commonly used tools, the Opioid Risk Tool (ORT), has 8 questions and has been validated in both cancer and noncancer pain. 24,25 Another self-administered tool is the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R), which has been validated in large groups of noncancer pain patients. 26,27 SOAPP-R is a 24-item self-reported list with good clinical applicability.…”

Section: Opioid Risk and Its Role In Palliative Medicinementioning

confidence: 99%

“…Tese behaviors include requests for dose escalation, emergency room visits, repeatedly seeking early prescription flls, doctor shopping, and forged prescriptions. 25 Not all aberrant behaviors are cause for concern. For example, if a patient is requesting early prescription reflls, it is important to distinguish between escalating tolerance, escalating pain, and addiction.…”

Section: Management Of Addiction Riskmentioning

confidence: 99%

Opioid risk assessment in palliative medicine

Dale

Edwards

Ballantyne

2016

J Community Support Oncol

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Pain management with opioids is an integral part of palliative medicine. As the doses and durations of opioid therapy increase, the inherent risks of opioid therapy rise. Although opioids are effective analgesics, they bring with them complex medical and psychological side effects. Aberrant behavior is dangerous and can be diffcult to identify as it results in a splitting in the goals of treatment between the patient and providers. One effective strategy in preventing that situation is through the early identifcation of at-risk patients. There are several tools that can help identify patients at higher risk of addiction and aberrant behaviors during opioid therapy. Structured use of these tools in conjunction with the clinic exam, regular follow-up visits, and lab testing can further reduce patient risk and improve success in opioid therapy. This article will review the background behind a structured strategy for opioid risk assessment using the Opioid Risk Tool, SOAPP-R, and DIRE tools. In addition, example aberrant behaviors and followup strategies will be reviewed. It will be demonstrated that careful screening and follow-up allow risk factors to be recognized and addressed early.

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“…Screening tools have been designed to prescreen patients prior to initiating opioids and to monitor patients who are currently using opioids. Examples of prescreening tools include the Opioid Risk Tool, 25 Screener and Opioid Assessment for Patients with Pain, 26 Diagnosis, Intractability, Risk, Efficacy, 27 and Drug Abuse Screening Test. 28 Tools used for monitoring patients currently receiving prescription opioids include Pain Assessment and Documentation Tool, 29 and the Current Opioid Misuse Measure.…”

Section: Case Study IVmentioning

confidence: 99%

Treating Pain in Addicted Patients: Recommendations from an Expert Panel

Cheatle

Comer

Wunsch³

et al. 2014

Population Health Management

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Clinicians may face pragmatic, ethical, and legal issues when treating addicted patients. Equal pressures exist for clinicians to always address the health care needs of these patients in addition to their addiction. Although controversial, mainly because of the lack of evidence regarding their long-term efficacy, the use of opioids for the treatment of chronic pain management is widespread. Their use for pain management in the addicted population can present even more challenges, especially when evaluating the likelihood of drug-seeking behavior. As the misuse and abuse of opioids continues to burgeon, clinicians must be particularly vigilant when prescribing chronic opioid therapy. The purpose of this article is to summarize recommendations from a recent meeting of experts convened to recommend how primary care physicians should approach treatment of chronic pain for addicted patients when an addiction specialist is not available for a referral. As there is a significant gap in guidelines and recommendations in this specific area of care, this article serves to create a foundation for expanding chronic pain guidelines in the area of treating the addicted population. This summary is designed to be a practical how-to guide for primary care physicians, discussing risk assessment, patient stratification, and recommended therapeutic approaches. (Population Health Management 2014;17:79-89)

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Predicting Aberrant Behaviors in Opioid-Treated Patients: Preliminary Validation of the Opioid Risk Tool

Cited by 938 publications

References 56 publications

Chronic Pain, Chronic Opioid Addiction: a Complex Nexus

Chronic Pain, Chronic Opioid Addiction: a Complex Nexus

Opioid risk assessment in palliative medicine

Treating Pain in Addicted Patients: Recommendations from an Expert Panel

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