Risk assessment and stratification have become a central issue in prescribing opioids to patients with chronic pain. Research to date on various risk screening measures has shown that a clinical interview by an experienced clinician offers superior predictive ability in identifying patients who are more likely to engage in future medication aberrant behavior. The current study represents a pilot study of an interview rating scale that is designed to replicate this clinical assessment. This study compares the predictions of medication aberrant behavior made by the Opioid Risk Tool, the Screener and Opioid Assessment for Patients with Pain-Revised, and the new interview rating scale, the Brief Risk Interview (BRI). A sample of 196 patients was assessed by each of the three risk measures and then follow-up data were gathered at 6 months post interview to determine which patients had engaged in medication aberrant behavior and had been discharged from the practice. The BRI shows superior predictive ability in identifying patients who later engage in medication aberrant behavior. Although more study in other settings is needed, these preliminary data suggest that the Brief Risk Interview could be a useful tool for any pain clinician in assessing risk through the use of information gathered in a brief interview.