Highlights
- •The Opioid Risk Tool was evaluated on pain patients with and without an opioid use disorder.
- •The opioid Risk Tool was able to discriminate between patients with and without opioid use disorders (odds ratio, 1.624).
- •An Opioid Risk Tool removing the preadolescent sexual abuse item had similar results (odds ratio, 1.648).
- •An unweighted Opioid Risk Tool without the sexual abuse item was superior (odds ratio, 3.085).
Abstract
The Opioid Risk Tool (ORT) is a commonly used measure of risk of aberrant drug-related
behaviors in patients with chronic pain prescribed opioid therapy. In this study,
the discriminant predictive validity of the ORT was evaluated in a unique cohort of
patients with chronic nonmalignant pain (CNMP) on long-term opioid therapy who displayed
no evidence of developing an opioid use disorder (OUD) and a sample of patients with
CNMP who developed an OUD after commencing opioid therapy. Results revealed that the
original ORT was able to discriminate between patients with and without OUDs (odds
ratio = 1.624; 95% confidence interval [CI] = 1.539–1.715, P < .001). A weighted ORT eliminating the gender-specific history of preadolescent
sexual abuse item revealed comparable results (odds ratio = 1.648, 95% CI = 1.539–1.742,
P < .001). A revised unweighted ORT removing the history of preadolescent sexual abuse
item was notably superior in predicting the development of OUD in patients with CNMP
on long-term opioid therapy (odds ratio = 3.085; 95% CI = 2.725–3.493; P < .001) with high specificity (.851; 95% CI = .811–.885), sensitivity (.854; 95%
CI = .799–.898), positive predictive value (.757; 95% CI = .709–.799), and negative
predictive value (.914; 95% CI = .885–.937).
Perspective: The revised ORT is the first tool developed on a unique cohort to predict the risk
of developing an OUD in patients with CNMP receiving opioid therapy, as opposed to
aberrant drug-related behaviors that can reflect a number of other issues. The revised
ORT has clinical usefulness in providing clinicians a simple, validated method to
rapidly screen for the risk of developing OUD in patients on or being considered for
opioid therapy.
Key words
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Article info
Publication history
Published online: January 25, 2019
Accepted:
January 22,
2019
Received in revised form:
November 20,
2018
Received:
September 21,
2018
Footnotes
Supported by the National Institutes of Health [NIH/NIDA R01 DA032776-05] (Cheatle, O'Brien), The Patrick and Catherine Weldon Donaghue Medical Research Foundation, and The New York Community Trust (Dhingra) and the van Ameringen Endowed Chair (Compton).
The authors have no conflicts of interest to declare.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
Identification
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© 2019 by the American Pain Society
