Opioid Risk Tool (ORT)

Patients experiencing chronic pain are already susceptible to cognitive impairment. One study reported cognitive deficits in 54% of patients, particularly in domains such as episodic memory and attention (McCracken and Iverson, 2001). For that reason, it is vital for clinicians prescribing pain medications to understand how opioids may further contribute to cognitive decline.

When it comes to prescription opioids and cognition, issues seem to arise during long-term use. Patients with prolonged use eventually develop a tolerance to prescription drugs and their dose must be subsequently increased (Anand et al., 2010). Higher doses lead to a decline in multiple areas of cognition (Khera and Rangasamy, 2021).

The cognitive implications may become more severe for some patients, as prescribed opioid use can often turn into opioid use disorder, especially given that cognitive impairment is a risk factor for substance abuse in and of itself (Krank and Goldstein, 2006). Long-term drug abuse has been known to alter brain function as well as structure, and studies have shown that the resulting cognitive deficits are prevalent in approximately one third of patients, with some persisting even post detoxification (Bruijnen et al., 2019).

Researchers have found that some patients seeking treatment for opioid addiction in particular score lower on tests of visuospatial ability compared to those in recovery for the use of other types of substances (Bruijnen et al., 2019), with attention, episodic memory and working memory also shown to be impaired (Kamboj et al., 2005; Sjøgren et al., 2004).

The opioid risk assessment questionnaire is commonly used by addiction clinics, pain clinics and professionals, mental health professionals, and other healthcare professionals, researchers, and individuals to screen for risk of drug abuse.

Up to 29% of patients being treated for chronic pain misuse opioids (Vowles et al., 2015), and opioid prescriptions for pain are on the rise (Berterame et al., 2016). Clinicians who work with chronic pain patients require a way of determining which of them require closer observation over the course of their care in order to spot the signs of substance use disorders.

Intended for individuals ages 16 years and older, the ORT is a self-report questionnaire containing 10 items that predict which individuals prescribed opioids for chronic pain are at risk for developing aberrant behaviors.

The patient places each of the 10 items in one of three categories—low, moderate, or high risk—with each item scored differently based on gender. The sum of all item scores determines the opioid abuse risk category for the individual.

The risk category can be low risk (0 to 3 points), moderate risk (4 to 7 points), or high risk (8 or more points). Patients who score within the high-risk category are the most likely to display aberrant behaviors.

The Opioid Risk Tool should be used as a screening tool to assist primary care providers, mental health professionals, addictions or pain specialists, or others in understanding pain medication use and abuse and monitoring behaviors over time.

Any conclusions drawn from the opioid risk assessment questionnaire should be paired with further assessment, such as clinical interviews and observations, additional mental health examinations or assessments, and evaluations of the patient’s level of distress, functional impairment, and/or family history.