Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool.
OBJECTIVE
To provide clinicians with a brief screening tool to predict accurately which individuals may develop aberrant behaviors when prescribed opioids for chronic pain.


METHODS
One hundred and eighty-five consecutive new patients treated in one pain clinic took the self-administered Opioid Risk Tool (ORT). The ORT measured the following risk factors associated in scientific literature with substance abuse: personal and family history of substance abuse; age; history of preadolescent sexual abuse; and certain psychological diseases. Patients received scores of 0-3 (low risk), 4-7 (moderate risk), or >or= 8 (high risk), indicating the probability of their displaying opioid-related aberrant behaviors. All patients were monitored for aberrant behaviors for 12 months after their initial visits.


RESULTS
For those patients with a risk category of low, 17 out of 18 (94.4%) did not display an aberrant behavior. For those patients with a risk category of high, 40 out of 44 (90.9%) did display an aberrant behavior. The authors used the c statistic to validate the ORT, because it simultaneously assesses sensitivity and specificity. The ORT displayed excellent discrimination for both the male (c = 0.82) and the female (c = 0.85) prognostic models.


CONCLUSIONS
In a preliminary study, among patients prescribed opioids for chronic pain, the ORT exhibited a high degree of sensitivity and specificity for determining which individuals are at risk for opioid-related, aberrant behaviors. Further studies in a variety of pain and nonpain settings are needed to determine the ORT's universal applicability.
Webster
Lynn R
LR
Lifetree Pain Clinic and Clinical Research, Salt Lake City, Utah 84106, USA. lynnw@lifetreepain.com
Webster
Rebecca M
RM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000379:methods; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D008875:Middle Aged; D009294:Narcotics / Q000009:adverse effects* / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D010146:Pain / Q000188:drug therapy / Q000453:epidemiology*; D010865:Pilot Projects; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D014589:Utah / Q000453:epidemiology
D009294:Narcotics