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

Area of Science:

• Pain Management
• Addiction Medicine
• Clinical Psychology

Background:

• The Opioid Risk Tool (ORT) is widely used to assess aberrant drug-related behaviors in patients on opioid therapy for chronic pain.
• Evaluating the ORT's predictive validity in a specific cohort is crucial for refining its clinical application.

Purpose of the Study:

• To evaluate the discriminant predictive validity of the Opioid Risk Tool (ORT) in patients with chronic nonmalignant pain (CNMP) on long-term opioid therapy.
• To compare the original ORT with modified versions in predicting the development of opioid use disorder (OUD).

Main Methods:

• The study assessed the ORT's predictive validity in a unique cohort of CNMP patients, comparing those who developed OUD with those who did not.
• Discriminant predictive validity was evaluated for the original ORT, a weighted ORT, and a revised unweighted ORT (excluding the preadolescent sexual abuse item).

Main Results:

• The original ORT discriminated between patients with and without OUDs (OR=1.624).
• A weighted ORT modification yielded comparable results (OR=1.648).
• A revised unweighted ORT, excluding the history of preadolescent sexual abuse, demonstrated superior prediction of OUD development (OR=3.085) with high sensitivity and specificity.

Conclusions:

• The revised ORT is the first tool developed on a unique cohort specifically to predict the risk of developing OUD in CNMP patients on opioid therapy.
• The revised ORT offers a simple, validated method for clinicians to screen patients for OUD risk, improving patient safety in long-term opioid management.