Usefulness of the opioid risk tool to predict aberrant drug-related behavior in patients receiving opioids for the treatment of chronic pain

Witkin, Lisa R.; Diskina, BS Dina; Fernandes, BS Shawn; Farrar, John T.; Ashburn, Mph Michael A.

doi:10.5055/jom.2013.0159

Cited by 21 publications

(13 citation statements)

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“…While it would be hoped that individual patient characteristics and risk screening tools might prove useful, when subjected to critical review, only a few individual patient characteristics (often identified in only 1 unreplicated study) helped identify patients at high risk, and no individual patient characteristics, other than the absence of a mood disorder, or screening tools appeared particularly useful for safely identifying patients at lower risk. Instead, most screening tools, including the commonly used Opioid Risk Tool, 35 , 36 were based on lower-quality studies or, when test performance was assessed by calculating LRs, demonstrated poor diagnostic performance.…”

Section: Discussionmentioning

confidence: 99%

Strategies to Identify Patient Risks of Prescription Opioid Addiction When Initiating Opioids for Pain

et al. 2019

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Key Points Question How can physicians identify patients with pain for whom prescription opioids can be safely prescribed? Findings This systematic review found that a history of opioid use disorder or other substance use disorder, a mental health diagnosis, and concomitant prescription of certain psychiatric medications may be associated with an increased risk of prescription opioid addiction. However, only the absence of a mood disorder appeared useful for identifying lower risk, and assessment tools incorporating combinations of patient characteristics and risk factors were not useful. Meaning This study suggests that there are few valid ways to identify patients who can be safely prescribed opioid analgesics.

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Section: Discussionmentioning

confidence: 99%

Strategies to Identify Patient Risks of Prescription Opioid Addiction When Initiating Opioids for Pain

et al. 2019

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“…In this study, the ORT was used retrospectively to separate patients into low or moderate–high risk categories for aberrant opioid use, but there were no differences in prescribing patterns or number of requested refills. This tool has traditionally been used to stratify patients undergoing management of chronic pain, although its utility has been called into question . There is no well‐established risk stratification tool in the acute pain setting.…”

Section: Discussionmentioning

confidence: 99%

Impact of perioperative pain management protocol on opioid prescribing patterns

et al. 2019

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Objectives/Hypothesis: The objective of this study was to demonstrate the impact of preoperative education, patient risk stratification, and a postoperative pain management protocol for common head and neck procedures on opioid prescribing patterns and postoperative pain reporting.Study Design: Retrospective cohort study. Methods: A postoperative pain management protocol was developed and implemented for patients undergoing head and neck surgical procedures. Medical charts were queried and postoperative patient satisfaction surveys were administered. Opioid prescribing patterns were evaluated in cohorts of patients undergoing procedures with anticipated mild pain (e.g., thyroidectomy, parotidectomy, lymph node biopsy) before and after the implementation of the protocol. Postoperative patient surveys were analyzed in the postimplementation group.Results: A total of 302 patients were included for analysis. One hundred fifty-four patients and 148 patients underwent surgery before and after the implementation of the protocol, respectively. There was a decreased incidence of oxycodonecontaining prescriptions (83% to 26%), and tramadol became the most common discharge medication (70%). There was a significant decrease in the total number of pills prescribed after the implementation of the protocol (34.71 to 25.36, P < .001). Ninety percent of patients reported high satisfaction (≥8) with pain management.Conclusions: This study shows that a comprehensive pain management protocol can significantly reduce the amount and potency of opioid pain medication prescribed after head and neck procedures while maintaining high patient satisfaction.

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“…Although very effective to treat acute pain, opioids comprise a number of serious adverse events; including misuse, abuse and/or addiction, as well as the possibility of inappropriately prolonged opioid use, and diversion (11,16). Therefore, various screening tools have been developed to assess the potential vulnerability of patients to develop aberrant behaviours.…”

Section: Discussionmentioning

confidence: 99%

“…The ORT is generally recognized by clinicians as a quick way of assessing patient's potential for developing drug-related aberrant behaviours. However, there has been criticism of the validity of the ORT in predicting these risks with accuracy (11). There are other tools that have been developed to predict risks of opioid-related aberrant behaviours (The Screener and Opioid Assessment for Patients with Pain (SOAPP) ® (12,13), and all of these tools agree that patients with a past history of substance use disorder are at higher risk of developing aberrant behaviours after long-term use of opioids; however, several studies have demonstrated that opioid-naïve patients may also display aberrant behaviours and become addicted to prescription opioids (14,15).Therefore, despite many endeavours to make risk assessment in clinical practice, there is relatively little empirical data about the measures' ability to assess and predict risk among opioid-naïve patients.…”

Section: Introductionmentioning

confidence: 99%

Long-term opioid use after discharge from inpatient musculoskeletal rehabilitation

Furlan¹,

Hassan²,

Famiyeh³

et al. 2016

J Rehabil Med

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Objective: To determine: (i) the prevalence of opioid-naïve patients discharged on opioids from a musculoskeletal rehabilitation inpatient unit; (ii) the prevalence of opioid use 6 months after discharge; and (iii) the efficacy of the Opioid Risk Tool in identifying long-term opioid use. Design: Prospective study. Participants: Sixty-four opioid-naïve patients who were exposed to opioids during admission and who were discharged on an opioid. Methods: Potentially eligible patients' charts were reviewed. Participants were interviewed during admission to obtain the opioid risk score and contacted 6 months after discharge via a semi-structured telephone interview. Results: Twenty-eight percent of opioid-naïve patients, who were discharged on opioids were still using opioids 6 months after discharge from rehabilitation. There was a trend for higher Opioid Risk Tool scores in those still using opioids than in individuals who were not using opioids at 6 months (p = 0.053). Conclusion:Patients who are prescribed opioids during a hospital admission should be screened for risk of opioid misuse. This data suggests that the Opioid Risk Tool could identify a patient's potential for becoming a long-term user of opioids.

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Usefulness of the opioid risk tool to predict aberrant drug-related behavior in patients receiving opioids for the treatment of chronic pain

Abstract: Neither the patient-completed nor the physician-completed ORT was strongly predictive of moderate-to-severe ADRB in patients receiving chronic opioid therapy for the treatment of noncancer pain in our pain center.

Cited by 21 publications

References 0 publications

Strategies to Identify Patient Risks of Prescription Opioid Addiction When Initiating Opioids for Pain

Strategies to Identify Patient Risks of Prescription Opioid Addiction When Initiating Opioids for Pain

Impact of perioperative pain management protocol on opioid prescribing patterns

Long-term opioid use after discharge from inpatient musculoskeletal rehabilitation

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