Understanding the Opioid Risk Tool (ORT): What to Do if You Are at Risk

October 17, 2022

Table of Contents

Should your doctor prescribe pain medication, or are you likely to misuse it? The opioid risk tool (ORT) was designed to answer this question.

The ORT is a screening questionnaire that is easy to administer. Doctors ask a series of questions, and patient responses are scored accordingly. High scores indicate you could be at risk for medication misuse, and your doctor might look for alternative therapies that don't use opioids to address your pain.

The ORT isn't perfect, and it's not the right tool for every person. However, it does help many doctors as a first step in understanding if the medications they're about to prescribe will put you at risk of developing an opioid dependency. 

What Is the Opioid Risk Tool?

The ORT is a simple, quick screening tool doctors use to assess addiction potential in their patients.

Yes No
Family history of abusing
Alcohol 1 0
Illicit drugs 1 0
Prescription medications 1 0
Personal history of abusing
Alcohol 1 0
Illicit drugs 1 0
Prescription drugs 1 0
Are you 16 to 45 years old? 1 0
Underlying illness
ADD, OCD, bipolar disorder, schizophrenia 1 0
Depression 1 0
Total

A score of two or lower indicates low risk for opioid misuse, while higher scores indicate greater risks.[1]

Doctors can administer and score the test in a few minutes during an office visit.[2]

The ORT is just one way of helping your doctor learn more about you and your individual risk for developing an OUD. It is certainly not a comprehensive way of determining whether or not opioid therapy is right for you, but is one tool doctors might use in developing a plan of care for your pain. [3] 

Why Do We Need the ORT?

Many people believe their pain should be treated with opioids first, and if problems develop, they can address them later. Doctors and addiction experts believe the opposite is true. By using screening tools, they can ensure that they don't cause patients additional (and unnecessary) harm or put them at risk of prolonged opioid exposure and subsequent risk for dependency.

Statistics make the problem of opioids easier to understand:

  • About 20% of people who go to the doctor with non-cancer pain get an opioid prescription.[4] 
  • Long-term opioid use often begins with acute pain. Treatment lasting more than a few days can put a person at risk for developing dependency [5]
  • In 2020, 9.3 million people 12 and older misused prescription opioids. Many of these individuals were first exposed to opioids through a prescription for pain from their doctor. [6]

Doctors can help to curb the opioid epidemic, but they need information. Tools like the ORT can help them gain a deeper understanding of their patients so they can respond with appropriate solutions.

What Should the ORT Be Used For?

Doctors may offer ORT screening before you start opioids for the first time, or if you have been using them for a while and you are trying to re-assess your risk. [1]

This tool shouldn't be used to determine who should or should not get opioid drugs. Instead, it should be used as one tool doctors can use to pay closer attention to which patients might need additional monitoring and support. [3]

Your doctor might use your score to help you both understand your risk of future opioid misuse and work with you to come up with a plan that both controls your pain but also keeps you safe. 

Does the ORT Work?

Researchers test tools like this before recommending them to doctors. They typically must prove that the assessments are sensitive enough to capture people in need, without excluding those who don't need additional help. The ORT has passed these tests.

In a 2005 study, researchers found that 5.6% of people in the low-risk cohort developed unusual addiction behavior in the following year compared to 90.9% in the high-risk category on the ORT.[7]

Subsequent studies have shown that the ORT is capable of helping discriminate between people with and without OUDs.[8] 

Alternatives to the ORT

Many screening tools for OUD exist, and some professionals may prefer other forms. Here are some of them:

Pain Medication Questionnaire (PMQ)

This 26-question survey places people into high-risk and low-risk categories for future opioid misuse.[9] 

Brief Risk Questionnaire (BRQ)

This survey contains 12 yes/no questions designed to help spot people who might misuse opioids if given a prescription.[9]

In head-to-head studies with the ORT, BRQ has proven superior at spotting dangerous thought patterns and behaviors. Researchers say it's almost as good as a long, structured, clinical interview.

Current Opioid Misuse Measure (COMM)

This test is made for people using opioids to assist with chronic pain problems. Pain and addiction experts developed the screening tool, and it's designed to help doctors understand if their current patients are developing dangerous habits and opinions involving their pain pills.[10]

Addiction Behaviors Checklist 

This survey contains 20 questions, and it's made for patients using opioids for chronic pain. Some questions are made for patients to answer, but others are based on what the doctor can observe during the test and in routine appointments.[11]

What to Do if You Are at Risk 

Your doctor administered the ORT, and your score is very high. What should happen next?

This is a decision that should be made mutually between you and your doctor. Some patients, after being made aware of the risks of chronic opioid use, may decide to continue therapy. Others may decide to try non-opioid medications or therapies in order to avoid or minimize their risk of dependency.

Non-opioid pain solutions include the following:[12]

  • Non-addicting pain medications: There are many non-opioid pain medications including tylenol, non-steroidal anti-inflammatory medications, muscle relaxers, and SNRIs. 
  • Physical therapy: A professional creates an exercise program to improve mobility and reduce pain. Massage and water therapy could be part of your program. Consistency is key to this treatment plan.
  • Acupuncture: Thin needles placed along your body could interrupt pain signals and bring relief. 
  • Injections: Local anesthetics or nerve blocks could block pain signals and deliver pain control.

The bottom line: long term opioid therapy carries risks. For some patients, these risks might outweigh the benefits. ORT and other screening tools help doctors and patients to understand the risks and benefits of using opioid therapy long term. They are just one tool for assessing your personal risk and helping to come up with a treatment plan that is right for you.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Opioid Risk Tool—OUD (ORT-OUD). National Institute on Drug Abuse. https://nida.nih.gov/nidamed-medical-health-professionals/screening-tools-resources/opioid-risk-tool-oud-ort-oud. May 2021. Accessed September 2022.
  2. Opioid Risk Tool. National Institute on Drug Abuse. https://nida.nih.gov/sites/default/files/opioidrisktool.pdf. Accessed September 2022.
  3. Another Look at the Opioid Risk Tool. Pain News Network. https://www.painnewsnetwork.org/stories/2022/6/29/another-look-at-the-opioid-risk-tool. June 2022. Accessed September 2022.
  4. CDC Guideline for Prescribing Opioids for Chronic Pain. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm. March 2016. Accessed September 2022.
  5. Guideline for Prescribing Opioids for Chronic Pain. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/pdf/prescribing/Guidelines_Factsheet-a.pdf. Accessed September 2022.
  6. About CDC's Opioid Prescribing Guideline. Centers for Disease Control and Prevention. https://www.cdc.gov/opioids/providers/prescribing/guideline.html. August 2022. Accessed September 2022.
  7. Predicting Aberrant Behaviors in Opioid-Treated Patients: Preliminary Validation of the Opioid Risk Tool. Pain Medicine. https://academic.oup.com/painmedicine/article/6/6/432/1853982. December 2005. Accessed September 2022.
  8. Development of the Revised Opioid Risk Tool to Predict Opioid Use Disorder in Patients with Chronic Nonmalignant Pain. The Journal of Pain. https://www.jpain.org/article/S1526-5900(18)30622-9/fulltext. July 2019. Accessed September 2022.
  9. Review of Opioid Risk Assessment Tools with the Growing Need for Telemedicine. Future Medicine. https://www.futuremedicine.com/doi/10.2217/pmt-2020-0064. December 2020. Accessed September 2022.
  10. Current Opioid Misuse Measure (COMM). PainEDU.org. https://depts.washington.edu/fammed/sixbuildingblocks/wp-content/uploads/sites/12/2018/02/Current-Opioid-Misuse-Measure.pdf. Accessed September 2022.
  11. The Addiction Behaviors Checklist: Validation of a New Clinician-Based Measure of Inappropriate Opioid Use in Chronic Pain. Journal of Pain and Symptom Management. https://www.jpsmjournal.com/article/S0885-3924(06)00441-6/fulltext. October 2006. Accessed September 2022.
  12. Non-Opioid Treatment. American Society of Anesthesiologists. https://www.asahq.org/madeforthismoment/pain-management/non-opioid-treatment/. Accessed September 2022. 
  13. Words Matter: Preferred Language for Talking About Addiction. National Institute on Drug Abuse. https://nida.nih.gov/research-topics/addiction-science/words-matter-preferred-language-talking-about-addiction. June 2021. Accessed September 2022.

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