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.
The Opioid Risk Tool (ORT) is a short questionnaire, now available in Creyos Health, that takes less than 5 minutes to complete. It can assist in determining which patients who have been prescribed opioids for chronic pain are at risk for opioid addiction.
Note: the ORT should be used to determine which patients taking opioids require closer observation during treatment based on their risk level. It should not be used to deny individuals of opioid prescriptions due to their ORT score.
The ORT was developed in 2005 by Lynn R. Webster and Rebecca M. Webster in order to predict which individuals taking prescription opioids for chronic pain are at risk of developing aberrant behaviors. It can be completed by patients age 16 and older and is a useful tool to help spot signs of opioid addiction, which could ultimately help reduce patient risk of opioid overdose.
The ORT measures several risk factors for opioid abuse. Despite consisting of only 10 questions, the Opioid Risk Tool exhibits a high degree of sensitivity and specificity for determining risk for aberrant opioid-related behaviors. These risk factors include personal as well as family history of substance abuse, age, history of preadolescent sexual abuse, and certain psychological conditions such as attention deficit disorder, obsessive-compulsive disorder, bipolar, schizophrenia, and depression.
Each of the 10 items on the ORT has a gender-specific number of associated points that is added to a patient's total score if that item is checked off as applicable. 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 developers of the ORT (Webster & Webster, 2005) found that amongst patients in the low risk category, approximately 94% do not exhibit any aberrant behavior, while approximately 90% of those in the high risk category do, speaking to the validity of this short yet effective questionnaire.
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 ORT, alongside the Pain Medication Questionnaire (PMQ), the Alcohol Use Disorders Identification Test (AUDIT), the Drug Abuse Screening Test (DAST-10) and Creyos Health’s validated neuropsychological tasks, can help clinicians keep track of these complex links between cognition and substance use, the severity of negative effects, and progression over the course of treatment.
The ORT is recommended to be completed by the patient during or before their initial visit and prior to finalizing any treatment plan that includes opioid therapy or prescription. With Creyos Health, administration is flexible and can be completed easily—either alone or within a protocol alongside cognitive tests or other questionnaires.
To include the ORT in a Creyos Health assessment, simply click on the Questionnaires section when creating a protocol and select the Opioid Risk Tool. Select any additional questionnaires or cognitive assessments in order to combine them all into one straightforward, customizable, and repeatable patient experience.
For detailed instructions on administering questionnaires within Creyos Health, please see our previous blog post on administering a computerized version of the PHQ-9.
The Creyos Health version of the ORT is digital and web-based, so the test can be given to a patient in-clinic or at home, requires no special training or hardware to administer, and no patient registration or login are required to complete the questionnaire. The ORT can also be added to a Creyos Health schedule, allowing you to automatically send it via email on a regular cadence. The results are scored instantly and added to an easy-to-interpret PDF. With minimal effort, healthcare providers, patients, and caregivers can all benefit from the valuable information provided by a standardized screening that looks for opioid dependence.
Creyos Health includes a multitude of cognitive tasks alongside built-in questionnaires for assessing areas of both mental and physical health. One such instrument is the Pain Medication Questionnaire, or the PMQ. The PMQ is similar to the ORT, but its focus is on screening patients who are already using pain medication, and on evaluating progress during a treatment program.
If there are any other questionnaires that you are using today as part of your practice that you would like to see become available in a computerized format within Creyos Health please do not hesitate to let us know by commenting on this blog post or by contacting us through email.