Purpose & Evidence:

  • Purpose: The Diagnosis, Intractability, Risk, Efficacy (DIRE) tool assesses the risk of opioid abuse and suitability of candidates for long-term opioid therapy
  • Target population: Adults
  • Evidence:
    • Validated by six experts studying patient case vignettes (Passik et al. 2008).
    • Showed sensitivity, efficacy, specificity and high internal consistency (Belgrade et al. 2006)
  • Advantages/Limitations


    • Specifically designed for primary care use (Passik et al. 2008)
    • Patient's DIRE score correlates well with patient compliance and efficacy of long-term opioid therapy (Belgrade et al. 2006)


    • Prospective validation needed (Passik et al. 2008).


Test features:

  • Estimated time: 7 items, less than 2 minutes to administer and score
  • Length: Prescreen, plus 7 items
  • Administered by: Patient Interview
  • Intended settings: Primary care


Available Formats & Links:

  • Available Formats:
    • DIRE Score: pdf available online from University of Colorado, Denver
    • DIRE Score to predict outcomes chronic opioid therapy for pain: iPhone app




View ReferencesHide References
Belgrade MJ, Schamber CD, Lindgren BR . The DIRE score: predicting outcomes of opioid prescribing for chronic pain. J Pain. 2006; 7: 671-81. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16942953 Accessed on: 2013-09-12.
Passik SD, Kirsh KL, Casper D. Addiction-related assessment tools and pain management: instruments for screening, treatment planning and monitoring compliance. Pain Med. 2008; 9: S145-S166.