Opioid Risk Tools are used by medical practitioners working in settings that may require treatment with opioid drugs. Their patients are usually struggling with acute or chronic pain and typically require these medications. A reliable risk assessment tool helps providers assess a patient’s risk for abusive drug-related behavior. Patients who score as “high risk” should be considered for other modalities of pain management or possible and their doctors should be cautious and remain vigilant in order to mitigate potential problems down the line.
Since so many substance use recovery patients began their relationship with narcotics in a pain management setting, it’s important to gather as much information as possible to understand their entire journey and what steps and assessments may have been taken in the past.
The Need for an Effective Opioid Risk Assessment
The opioid epidemic is one of the top public health concerns in the United States. The number of deaths from drug overdoses is steadily increasing from year to year. Between 2018 and 2019, prescription opioid-related death rates increased by 7%. In the past 10 years, more than half a million people died after overdosing on prescription and illicit opioids.
The opioid crisis is often mistakenly attributed to non-medical use or abuse. According to the opioid prescription history, the main driver behind the pandemic is the overwhelming use of prescription opioids for non-cancer pain management.
- More than 85% of people who use heroin turned to it after taking prescription opioids.
- A person who is addicted to opioid painkillers is 40 times more likely to become a heroin user than non-opioid users.
In 1996, the opioid abuse rate started increasing exponentially. In part, the abuse rate growth was initiated by the development of OxyContin, a prescription version of oxycodone.
OxyContin manufacturer Purdue Pharma launched thousands of pain-related educational programs and campaigns to encourage the use of prescription opioids for long-term non-cancer pain management. At about the same time, the American Pain Society and the American Academy of Pain Medicine issued statements that endorsed opioid use for chronic non-cancer pain management.
After this “opioid revolution,” many physicians started prescribing opioids for pain management. These decisions were based on a variety of studies, which claimed that the risk of developing an OUD was minor. However, many of these studies were incomplete. Meanwhile, long-term clinical trials to prove the safety of using opioids for long-term treatment were never conducted.
A study published in the Journal of Hospital Medicine in 2014 showed that physicians prescribed opioids in 51% of more than a million non-surgical admissions across 286 U.S. hospitals.
Essential Components of Opioid Risk Tools
There are many different kinds of opioid risk tools at the disposal of physicians. First, we’ll take a look at the Opioid risk Tool developed by Lynn R Webster, MD, and what makes his tool so effective. His ORT assesses the genetic and environmental factors that make a person vulnerable.
A Positive Patient-Provider Relationship
Since opioid risk tools are self-report screening tools, the information provided is entirely at the discretion of the patient. A positive patient-provider relationship fosters an environment of truthfulness, where patients feel safe disclosing such intimate information, that is likely emotionally charged or triggering, in an already vulnerable medical setting.
An established relationship with patients, allows providers to receive the most accurate information as early in the treatment process as possible.
Updates with New information
On a similar thread, it is not uncommon for new information to become apparent to a provider as their relationship with the patient improves or as treatment continues. Effective opioid risk tools are not one and done. They should be updated as these elements of a patient’s history are uncovered.
Mandatory Responses
Whether performing an assessment verbally, on paper, or through a virtual form, it’s critical that all questions be answered for accurate scoring. To err is human, but it is important to not leave any optional fields in online forms or to omit any information with other assessment methods.
Understanding the Limitations
It is important to understand that the results generated from an opioid risk tool should be used in conjunction with other assessments when diagnosing substance abuse disorders. These tools merely provide an assessment of the potential risk for related behavior and are not a predictor of addiction. Anyone can develop a narcotics addiction regardless of their ORT score.
The chances of developing an OUD depend on a variety of factors, including the duration of treatment, medical history, social support, family history, substance abuse incidents, and much more.
Other considerations include
- Opioids are received for more than 30 days.
- The daily dose of prescribed opioids is greater than 120 MME.
- Simultaneous use of opioids and atypical antipsychotic agents.
- Opioids prescribed by multiple prescribers (as indicated by PDMP).
Other Risk Assessments
Depending on the patient’s individual traits and medical history, a physician can choose to administer other risk assessment tools. The most common instruments include:
SOAPP – R (Screener and Opioid Assessment for Patients with Pain)
SOAPP – R is a questionnaire completed by the patient. It consists of 24 questions, which the patient answers by choosing one of the following options:
- Never — 0
- Seldom — 1
- Sometimes — 2
- Often — 3
- Very often — 4
Similar to ORT, SOAPP-R evaluates the patient’s previous drug and alcohol abuse history. It also assesses such factors as mood swings, sexual abuse, the feeling of boredom, concerns with medication, and more.
Patients with a low risk of aberrant opioid use earn less than 9 points. Moderate risk is between 10 and 21 points. High risk is 22 points and greater. In practice, the cutoff score is usually based on the clinician’s judgment.
SISAP (Screening Instrument for Substance Abuse Potential)
This questionnaire consists of five questions:
- How many alcoholic drinks do you have per day?
- How many alcoholic drinks do you have per week?
- Did you use marijuana/hashish in the past year?
- Have you ever smoked cigarettes?
- What is your age?
According to this test, the clinician should use caution when prescribing opioids to:
- Men who have more than 4 drinks per day or more than 16 per week.
- Women who have more than 3 drinks per day or more than 12 per week.
- Patients who confirm marijuana/hashish use in the past 12 months.
- A patient under 40 who smokes.
Just like other tools, the SISAP questionnaire takes less than a minute to complete. However, it fully relies on the assumption that the patient is telling the truth.
DIRE (Diagnosis, Intractability, Risk, and Efficacy Score)
This tool is designed for primary care physicians to use to figure if the patient is a suitable candidate for long-term opioid therapy. The “RISK” part of the instrument evaluates the risk of opioid dependency for each patient. It considers the following factors:
- Psychological — the severity of personality dysfunction or mental illness.
- Chemical Health — active or recent use of illicit drugs and alcohol.
- Reliability — history of medication misuse and treatment compliance.
- Social support — support from family and friends, close relationships.
DIRE is a comprehensive assessment tool that takes more time to administer than the rest of the instruments. However, it doesn’t just identify risks but also considers numerous other factors to predict the patient’s behavior with opioids.
A Comprehensive Approach
As a substance use recovery or behavioral health organization, you don’t need to be told how imperative it is to prevent opioid dependency by identifying which patients are at risk. Preventive measures are a major weapon against the prescription opioid epidemic. A comprehensive approach can identify at-risk patients timely and adjust their treatment accordingly. This approach also better prepares providers who will support patients through addiction recovery, should that come to be. Trust an interoperable EHR like Procentive to help your providers evaluate and document patient care. Schedule a demo today to see all of what Procentive has to offer.
