A revised version of the Opioid Risk Tool (ORT) was found to identify the risk for developing opioid use disorder in patients on long-term opioid therapy for chronic nonmalignant pain (CNMP) with high specificity and sensitivity, according to a study published in the Journal of Pain.
The ORT is a 10-item, brief, primary care physician-administered, self-report tool designed to evaluate the risk for opioid-related aberrant drug-related behaviors (ADRB). The data of 1178 patients with CNMP who were on long-term opioid therapy were included in this secondary analysis. The predictive validity of the ORT was evaluated in patients with vs without opioid use disorder. Electronic medical records were reviewed each month for 12 months following completion of baseline evaluations. Assessments were administered over the phone by trained research assistants.
The original ORT was found to be effective in discriminating between patients with vs without opioid use disorders (odds ratio [OR], 1.624; 95% CI, 1.539-1.715; P <.001). A weighted ORT in which the gender-specific history of pre-adolescent sexual abuse was removed had comparable efficacy (OR, 1.648; 95% CI, 1.539-1.742; P <.001). The revised unweighted ORT in which the history of pre-adolescent sexual abuse was removed was found to be more powerful than the original ORT in predicting opioid use disorder in patients with CNMP on long-term opioid therapy (OR, 3.085; 95% CI, 2.725-3.493; P <.001). The revised unweighted ORT had high specificity (0.851; 95% CI, 0.811- 0.885), sensitivity (0.854; 95% CI, 0.799-0.898), positive predictive value (0.757; 95% CI, 0.709-0.799), and negative predictive value (0.914; 95% CI, 0.885-0.937).
Study limitations include its cross-sectional nature, the predominantly white population, and the self-reporting vs objective nature of the ORT.
“The ORT like all risk assessment tools is limited in scope to providing an assessment of risk of ADRB which may or may not be indicative of a patient having developed a true opioid use disorder but is useful in alerting a clinician to the possibility of misuse, abuse, or opioid use disorder and prompting further investigation,” noted the study authors. “Despite these limitations, these psychometric analyses represent a significant step forward in our ability to screen for risk in patients with CNMP who are candidates for long-term opioid therapy,”they added.
Cheatle MD, Compton PA, Dhingra L, Wasser TE, O’Brien CP. Development of the revised opioid risk tool to predict opioid use disorder in patients with chronic nonmalignant pain [published online January 26, 2019]. J Pain. doi:10.1016/j.jpain.2019.01.011