Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool

Pain Med. 2005 Nov-Dec;6(6):432-42. doi: 10.1111/j.1526-4637.2005.00072.x.


Objective: To provide clinicians with a brief screening tool to predict accurately which individuals may develop aberrant behaviors when prescribed opioids for chronic pain.

Design: One hundred and eighty-five consecutive new patients treated in one pain clinic took the self-administered Opioid Risk Tool (ORT). The ORT measured the following risk factors associated in scientific literature with substance abuse: personal and family history of substance abuse; age; history of preadolescent sexual abuse; and certain psychological diseases. Patients received scores of 0-3 (low risk), 4-7 (moderate risk), or >or= 8 (high risk), indicating the probability of their displaying opioid-related aberrant behaviors. All patients were monitored for aberrant behaviors for 12 months after their initial visits.

Results: For those patients with a risk category of low, 17 out of 18 (94.4%) did not display an aberrant behavior. For those patients with a risk category of high, 40 out of 44 (90.9%) did display an aberrant behavior. The authors used the c statistic to validate the ORT, because it simultaneously assesses sensitivity and specificity. The ORT displayed excellent discrimination for both the male (c = 0.82) and the female (c = 0.85) prognostic models.

Conclusion: In a preliminary study, among patients prescribed opioids for chronic pain, the ORT exhibited a high degree of sensitivity and specificity for determining which individuals are at risk for opioid-related, aberrant behaviors. Further studies in a variety of pain and nonpain settings are needed to determine the ORT's universal applicability.

Publication types

  • Controlled Clinical Trial
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Male
  • Medical History Taking / methods
  • Mental Disorders / diagnosis*
  • Mental Disorders / epidemiology*
  • Mental Disorders / prevention & control
  • Middle Aged
  • Narcotics / adverse effects*
  • Narcotics / therapeutic use
  • Opioid-Related Disorders / diagnosis*
  • Opioid-Related Disorders / epidemiology*
  • Opioid-Related Disorders / prevention & control
  • Pain / drug therapy
  • Pain / epidemiology*
  • Pilot Projects
  • Prognosis
  • Proportional Hazards Models
  • Reproducibility of Results
  • Risk Assessment / methods*
  • Risk Factors
  • Sensitivity and Specificity
  • Sex Distribution
  • Surveys and Questionnaires
  • Utah / epidemiology


  • Narcotics