What tools are available to risk stratify patients prior to initiating opioid therapy?
Several screening tools are available to help providers assess a patient’s risk prior to initiating opioid therapy or determining misuse/abuse of an opioid medication. Some include the Opioid Risk Tool (ORT), Diagnosis Intractability Risk Efficacy (DIRE) Score, Prescription Drug Use Questionnaire (PDUQ), and Screener and Opioid Assessment for Patients With Pain—Revised (SOAPP-R), while examples of opioid misuse tools include the Addiction Behaviors Checklist (ABC), Current Opioid Misuse Measure (COMM), and the Pain Assessment and Documentation Tool (PADT). It is recommended that at least one tool be utilized before initiation of chronic opioid therapy. Additionally, Zedler et al. developed the risk index for overdose or serious opioid-induced respiratory depression (RIOSORD) score, a risk stratification tool that was validated in a veteran population of almost 2 million patients to determine probability of an overdose of serious opioid-induced respiratory depression qualifying patients for in home naloxone. A civilian score of similar design is also available. Urine drug screens, serum drug monitoring, state prescription drug monitoring, and pill counts are all also useful tools to help reduce risk of abuse and misuse while a patient is actively receiving opioid therapy.