Usefulness of the opioid risk tool to predict aberrant drug-related behavior in patients receiving opioids for the treatment of chronic pain
Objective: The purpose of this study was to determine if the opioid risk tool (ORT) was clinically useful in guiding physician decision making during chronic opioid therapy and to determine whether there were differences between the patientcompleted and physician-completed ORT.
Design: Retrospective review of prospectively collected data.
Setting: A single-center tertiary care outpatient pain management center.
Patients, participants: One-hundred twenty-five patients who received chronic opioids as part of their pain therapy.
Interventions: Patients receiving care were asked to complete the ORT as part of their initial evaluation. In addition, as part of this study, a pain physician reviewed the information available at the time of the initial evaluation and completed the ORT. Medical records were reviewed for evidence of moderate-to-severe aberrant drug-related behavior (ADRB), according to specified criteria.
Main outcome measures: Patient-completed and physician-completed ORT and presence or absence of moderate to severe ADRB.
Results: Of the 125 patients included in this study, physician-completed ORT was available for 125 patients, and a patient-completed ORT was available on 87 of these patients. There was good correlation between the patient-completed and physician-completed ORT (correlation coefficient = 0.61). There were 112 observations of ADRB in 53 of 125 patients (42.4 percent) during the observation period of an average of 7.8 months (range 2-17 months). Of these 53 patients, 32 (60.4 percent) were identified by urine drug screen (UDS) alone, 7 (13.2 percent) were identified by physician observation alone, and 14 (26.4 percent) were identified by both UDS and physician observation. Based on the physician-completed ORT, 41 of 106 (38.7 percent) low risk patients had ADRB, compared to 8 of 14 (57.1 percent) moderate risk, and 4 of 5 (80 percent) high risk patients.
Conclusions: 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.
Keywords: aberrant drug-related behavior, opioid risk tool, risk assessment tools
Centers for Disease Control and Prevention (CDC): Unintentional poisoning deaths—United States, 1999-2004. MMWR Morbidity and Mortality Weekly Report. 2007; 56(5): 93-96.
Drug Abuse Warning Network: National Estimated of Drug-Related Emergency Department Visits. Rockville, MD: Substance Abuse and Mental Health Services Adminstration, 2010.
Gilson AM, Ryan KM, Joranson DE, et al.: A reassessment of trends in the medical use and abuse of opioid analgesics and implications for diversion control: 1997-2002. J Pain Symptom Manage. 2004; 28(2): 176-188.
Inter-university Consortium for Political and Social Research: Treatment Episode Data Set (TEDS), 2005. Icpsr 4626. Ann Arbor, MI: Inter-university Consortium for Political and Social Research distributor, 2007. Available at http://hdl.library.upenn.edu/1017.12/497468. Accessed February 25, 2013.
Passik SD, Kirsh KL: The interface between pain and drug abuse and the evolution of strategies to optimize pain management while minimizing drug abuse. Exp Clin Psychopharmacol. 2008; 16(5): 400-404.
Substance Abuse and Mental Health Services Adminstration: 2007 National Survey on Drug Use and Health Report: Patterns and Trends in Nonmedical Prescription Pain Reliever Use: 2002-2005 2008. Rockville, MD: Office of Applied Studies, NSDUH, DHHS, 2010.
Kessler RC, McGonagle KA, Zhao S, et al.: Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994; 51(1): 8-19.
Fals-Stewart W, Schafer J, Steve Lucente, et al.: Neurobehavioral consequences of prolonged alcohol and substance abuse: A review of findings and treatment implications. Clin Psyc Rev. 1994; 14(8): 755-788.
McNicol E, Horowicz-Mehler N, Fisk RA, et al.: Management of opioid side effects in cancer-related and chronic noncancer pain: A systematic review. J Pain. 2003; 4(5): 231-256.
Portenoy RK: Opioid therapy for chronic nonmalignant pain: A review of the critical issues. J Pain Symptom Manage. 1996; 11(4): 203-217.
Savage SR: Opioid therapy of chronic pain: Assessment of consequences. Acta Anaesthesiol Scand. 1999; 43(9): 909-917.
Jan SA: Introduction: Landscape of opioid dependence. J Manag Care Pharm. 2010; 16(1 Suppl B): S4-S8.
Hanson K: A pill problem: Prescription drug abuse is the fastest growing form of substance abuse. State Legis. 2010; 36(3): 22-25.
Bronstein AC, Spyker DA, Cantilena LR Jr, et al.: 2010 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 28th Annual Report. Clin Toxicol (Phila). 2011; 49(10): 910-941.
Okie S: A flood of opioids, a rising tide of deaths. N Engl J Med. 2010; 363(21): 1981-1985.
Chou R, Fanciullo GJ, Fine PG, et al.: Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009; 10(2): 113-130.
Jones T, Moore T, Levy JL, et al.: A comparison of various risk screening methods in predicting discharge from opioid treatment. Clin J Pain. 2012; 28(2): 93-100.
Passik SD, Kirsh KL: The need to identify predictors of aberrant drug-related behavior and addiction in patients being treated with opioids for pain. Pain Med. 2003; 4(2): 186-189.
Webster LR, Webster RM: Predicting aberrant behaviors in opioid-treated patients: Preliminary validation of the opioid risk tool. Pain Med. 2005; 6(6): 432-442.
Jones T, Passik SD: A comparison of methods of administering the opioid risk tool. J Opioid Manage. 2011; 7(5): 347-351.
Katz NP, Sherburne S, Beach M, et al.: Behavioral monitoring and urine toxicology testing in patients receiving long-term opioid therapy. Anesth Analg. 2003; 97(4): 1097-1102; table of contents.
Moore TM, Jones T, Browder JH, et al.: A comparison of common screening methods for predicting aberrant drug-related behavior among patients receiving opioids for chronic pain management. Pain Med. 2009; 10(8): 1426-1433.
Ready LB, Sarkis E, Turner JA: Self-reported vs. actual use of medications in chronic pain patients. Pain. 1982; 12(3): 285-294.
Kirsh KL, Whitcomb LA, Donaghy K, et al.: Abuse and addiction issues in medically ill patients with pain: Attempts at clarification of terms and empirical study. Clin J Pain. 2002; 18(4 Suppl): S52-S60.
Katz N, Fanciullo GJ: Role of urine toxicology testing in the management of chronic opioid therapy. Clin J Pain. 2002; 18(4 Suppl): S76-S82.
Fitzgibbon DR, Rathmell JP, Michna E, et al.: Malpractice claims associated with medication management for chronic pain. Anesthesiology. 2010; 112(4): 948-956.
Chou R, Fanciullo GJ, Fine PG, et al.: Opioids for chronic noncancer pain: Prediction and identification of aberrant drug-related behaviors: A review of the evidence for an American Pain Society and American Academy of Pain Medicine clinical practice guideline. J Pain. 2009; 10(2): 131-146.
Belgrade MJ, Schamber CD, Lindgren BR: The DIRE score: Predicting outcomes of opioid prescribing for chronic pain. J Pain. 2006; 7(9): 671-681.
Starrels JL, Becker WC, Alford DP, et al.: Systematic review: Treatment agreements and urine drug testing to reduce opioid misuse in patients with chronic pain. Ann Intern Med. 2010; 152(11): 712-720.
Passik SD, Heit H, Kirsh KL: Reality and responsibility: A commentary on the treatment of pain and suffering in a drug-using society. J Opioid Manage. 2006; 2(3): 123-127.
How to Cite
Copyright 2005-2023, Weston Medical Publishing, LLC
All Rights Reserved