Development of the Revised Opioid Risk Tool to Predict Opioid Use Disorder in Patients with Chronic Nonmalignant Pain

• Published in: The journal of pain Vol. 20; no. 7; pp. 842 - 851
• Main Authors: Cheatle, Martin D., Compton, Peggy A., Dhingra, Lara, Wasser, Thomas E., O'Brien, Charles P.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2019
• Subjects: chronic nonmalignant pain; long-term opioid therapy; Opioid Risk Tool; opioid use disorder; opioid use disorder; chronic nonmalignant pain; Opioid Risk Tool; long-term opioid therapy
• ISSN: 1526-5900; 1528-8447; 1528-8447
• DOI: 10.1016/j.jpain.2019.01.011

•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). 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.