Risk Assessment Tools
The treatment of chronic pain through opioid therapy involves a risk of possible dependence or abuse of the prescribed substances. While substance abuse tools assess whether a patient was or is currently involved in alcohol or drug abuse, risk assessment tools measure additional factors involved in a patient's overall level of risk of developing abuse or addiction. Beyond taking a good medical history via effective patient interview, there are several risk assessment tools that may be used to further evaluate how likely it is that patients will have difficulty using opioid analgesics as prescribed. The biggest identified risk factors for substance abuse are:
- Personal or family history of aberrant alcohol and drug-related behaviors
- History of physical or sexual abuse
- Co-occurring psychiatric conditions
(Chou et al. 2009).
Who should be screened for risk of substance abuse?
All patients being considered for chronic opioid therapy should be screened for risk of substance misuse.
When should patients be screened for risk of substance abuse?
Screen for risk before prescribing opioids. It is ideally done on the patient's first visit or before prescribing opioids, although even patients who have been taking opioids for long periods of time should be routinely screened.
Choice of substance abuse risk assessment tools may depend on time available, substance involved, format to be used (paper, computer, interview), and depth desired. There are a number of screening tools that have been developed specifically to screen for risk of opioid misuse in the context of chronic pain treatment and that have been demonstrated to have predictive value; these tools may be helpful in determining relative risk in addition to the medical history. A recent review found that the ORT, DIRE, and SOAPP-R assessment tools appear to have good validity (Chou et al. 2009). However, more research is needed to determine the extent to which they predict clinical outcomes (Chou et al. 2009). Reducing the risk in opioid prescribing involves an assessment of the risk involved and an accommodation of that risk into the treatment.
This section focuses on the following widely used risk assessment tools: ORT, DIRE, SOAPP-R, and SISAP.