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Opioid Risk Tool

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1. Prospective screening with the validated Opioid Risk Tool demonstrates gynecologic oncology patients are at low risk for opioid misuse. (PubMed)

Prospective screening with the validated Opioid Risk Tool demonstrates gynecologic oncology patients are at low risk for opioid misuse. To characterize risk for opioid misuse among gynecologic oncology patients.The Opioid Risk Tool (ORT), a validated screen for opioid misuse risk, was administered to a convenience sample of patients with gynecologic cancer receiving opioid prescriptions in gynecologic oncology or palliative care clinics from January 2012-June 2016. Demographic and clinical (...) categorized as low-risk for opioid misuse, 7% as moderate-risk, and 6% as high-risk. Patients who were at moderate or high-risk of opioid misuse were significantly younger (47 vs. 58years, p=0.02), more likely to have cervical cancer (p=0.02), be smokers (p=0.01) and be uninsured or on Medicare (p=0.03).Most gynecologic oncology patients in our cohort were low-risk for opioid misuse (87%). Cervical cancer patients were more likely to be moderate to high-risk for misuse. Future screening efforts for opioid

2017 Gynecologic Oncology

2. Randomized program evaluation of the Veterans Health Administration Stratification Tool for Opioid Risk Mitigation (STORM): A research and clinical operations partnership to examine effectiveness. (PubMed)

Randomized program evaluation of the Veterans Health Administration Stratification Tool for Opioid Risk Mitigation (STORM): A research and clinical operations partnership to examine effectiveness. The United States is facing an opioid crisis in which overdose is the leading cause of injury death-misuse of opioids constitutes the vast majority of those deaths. In 2016 alone, over 42,000 people died from opioid overdose, an increase of 27% from the prior year. Deployment of the Stratification (...) Tool for Opioid Risk Mitigation (STORM), a clinical decision support tool to improve opioid safety, is one response by the Veterans Health Administration (VHA) to the opioid crisis. STORM identifies VHA patients at very high risk of opioid-related adverse events and lists potential risk mitigation strategies. Deployment of STORM also helps VHA meet certain requirements of the Comprehensive Addiction and Recovery Act of 2016. In alignment with the VHA's learning health care system initiative

2019 Substance Abuse Controlled trial quality: uncertain

3. Protocol for evaluating the nationwide implementation of the VA Stratification Tool for Opioid Risk Management (STORM). (PubMed)

Protocol for evaluating the nationwide implementation of the VA Stratification Tool for Opioid Risk Management (STORM). Mitigating the risks of adverse outcomes from opioids is critical. Thus, the Veterans Affairs (VA) Healthcare System developed the Stratification Tool for Opioid Risk Management (STORM), a dashboard to assist clinicians with opioid risk evaluation and mitigation. Updated daily, STORM calculates a "risk score" of adverse outcomes (e.g., suicide-related events, overdoses (...) , overdose death) from variables in the VA medical record for all patients with an opioid prescription and displays this information along with documentation of recommended risk mitigation strategies and non-opioid pain treatments. In March 2018, the VA issued a policy notice requiring VA Medical Centers (VAMCs) to complete case reviews for patients whom STORM identifies as very high-risk (i.e., top 1% of STORM risk scores). Half of VAMCs were randomly assigned notices that also stated that additional

2019 Implementation Science

4. Screening in Trauma for Opioid Misuse Prevention (STOMP): study protocol for the development of an opioid risk screening tool for victims of injury (PubMed)

Screening in Trauma for Opioid Misuse Prevention (STOMP): study protocol for the development of an opioid risk screening tool for victims of injury Opioid addiction and overdose are epidemic in the U.S. Victims of traumatic injury are at greater than average risk for opioid misuse and related complications. Potential risk screens and preventive interventions in this clinical population remain under-investigated. The current project seeks to develop and pilot the implementation of a screening (...) tool for opioid risk at American College of Surgeons (ACS) Level I and Level II trauma centers.The project began with an online survey, which was sent to Wisconsin trauma center medical directors and trauma coordinators for the purpose of gathering information on current substance use screening practices. Next, a focus group of trauma center staff was convened to discuss barriers and facilitators to screening, resources available and needed to support trauma patients with opioid use disorders

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2017 Addiction science & clinical practice

5. Re-assessing the Validity of the Opioid Risk Tool in a Tertiary Academic Pain Management Center Population. (PubMed)

Re-assessing the Validity of the Opioid Risk Tool in a Tertiary Academic Pain Management Center Population. To analyze the validity of the Opioid Risk Tool (ORT) in a large. diverse population.A cross-sectional descriptive study.Academic tertiary pain management center.A total of 225 consecutive new patients, aged 18 years or older.Data collection included demographics, ORT scores, aberrant behaviors, pain intensity scores, opioid type and dose, smoking status, employment, and marital status.In (...) this population, we were not able to replicate the findings of the initial ORT study. Self-report was no better than chance in predicting those who would have an opioid aberrant behavior. The ORT risk variables did not predict aberrant behaviors in either gender group. There was significant disparity in the scores between self-reported ORT and the ORT supplemented with medical record data (enhanced ORT). Using the enhanced ORT, high-risk patients were 2.5 times more likely to have an aberrant behavior than

2018 Pain Medicine

6. Risk of behaviour suggestive of opioid abuse: a protocol for a systematic review of validated assessment tools. (PubMed)

Risk of behaviour suggestive of opioid abuse: a protocol for a systematic review of validated assessment tools. Opioid use patterns of individuals with non-cancer pain are influenced by the behavioural dynamics of the individual in managing and properly following the prescription. The use of assessment tools for measuring the risk of behaviour suggestive of opioid abuse is important for health professionals who provide care to individuals with non-cancer pain. The aim of the proposed review (...) is to analyse the psychometric properties of tools for measuring the risk of behaviour suggestive of opioid abuse in adults with non-cancer pain.The review process will be based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. The Consensus-Based Standards for the Selection of Health Measurement Instruments will be used to analyse the assessment tools. Two independent reviewers will perform the literature search and analysis procedures. Searches will be performed on PubMed

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2018 BMJ open

7. Impact of Medical Marijuana Legalization on Opioid Use, Chronic Opioid Use, and High-risk Opioid Use. (PubMed)

the sensitivity analyses. The falsification tests showed no association between medical marijuana legalization and prescriptions for antihyperlipidemics (OR = 1.00; CI 0.99-1.01) or antihypertensives (OR = 1.00; CI 0.99-1.01).In states where marijuana is available through medical channels, a modestly lower rate of opioid and high-risk opioid prescribing was observed. Policy makers could consider medical marijuana legalization as a tool that may modestly reduce chronic and high-risk opioid use. However (...) Impact of Medical Marijuana Legalization on Opioid Use, Chronic Opioid Use, and High-risk Opioid Use. To determine the association of medical marijuana legalization with prescription opioid utilization.A 10% sample of a nationally representative database of commercially insured population was used to gather information on opioid use, chronic opioid use, and high-risk opioid use for the years 2006-2014. Adults with pharmacy and medical benefits for the entire calendar year were included

2019 Journal of General Internal Medicine

8. Randomised controlled trial: Non-opioid analgesia is as effective as opioid management in acute pain and supports a change in prescribing practice to help address the ‘opioid epidemic’

, Iyengar R , Bothra A , et al . A Tool to Assess Risk of De Novo Opioid Abuse or Dependence . 4. Chang AK , Bijur PE , Esses D , et al . Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity Pain in the emergency department: a randomized controlled clinical trial . 5. Oxford Pain Group . Oxford league table of analgesics in acute pain . 2007 6. Moore RA , Wiffen PJ , Derry S , et al . Non-prescription (OTC) oral analgesics for acute pain - an overview of Cochrane reviews (...) in other patient groups is required. Context Opioid analgesics are the first-line treatment for moderate to severe pain in the emergency department (ED) despite concerns about the ‘opioid epidemic’. The opioid epidemic refers to a rapid increase in the use of opioids in the USA and Canada that began in the 1990s, recently reframed as a public health emergency. Long-term opioids use often begins with a prescription for an acute pain problem, and is associated with an increased risk of dependence

2018 Evidence-Based Nursing

9. Evaluation of a Medicaid Lock-in Program: Increased Use of Opioid Use Disorder Treatment but No Impact on Opioid Overdose Risk. (PubMed)

Evaluation of a Medicaid Lock-in Program: Increased Use of Opioid Use Disorder Treatment but No Impact on Opioid Overdose Risk. "Lock-in" programs (LIPs) identify beneficiaries demonstrating potential overutilization of opioids, and other controlled substances, and restrict their access to these medications. LIPs are expanding to address the opioid crisis and could be an effective tool for connecting people to opioid use disorder treatment. We examined the immediate and sustained effects (...) of a Medicaid LIP on overdose risk and use of medication-assisted treatment (MAT) for opioid use disorder.We analyzed North Carolina Medicaid claims from July 2009 through June 2013. We estimated daily risk differences and ratios of MAT use and overdose during lock-in and following release from the program, compared with periods before program enrollment.The daily probability of MAT use during lock-in and following release was greater, when compared with a period just before LIP enrollment [daily risk

2019 Medical Care

10. Screening Tools Validated in the Outpatient Pain Management Setting Poorly Predict Opioid Misuse in the Emergency Department: A Pilot Study. (PubMed)

the effectiveness of three commonly used screening tools, previously validated in outpatient pain management settings, to assess risk of opioid misuse in ED patients.This was a prospective observational study of 154 participants (median age 50 years; 49.6% female) presenting to an academic ED for a chief complaint of pain ≥ 6 months or an opioid refill request. Participants completed the Opioid Risk Tool, the Screener and Opioid Assessment for Patients with Pain-Revised, and the Current Opioid Misuse Measure (...) Screening Tools Validated in the Outpatient Pain Management Setting Poorly Predict Opioid Misuse in the Emergency Department: A Pilot Study. Currently, no universally accepted methods exist to assess drug-related aberrant behaviors in emergency department (ED) patients. There are several screening tools to identify opioid misuse in patients with chronic pain, however, the validity of these screening tools to assess for misuse within the ED remains unclear.This study investigated

2019 Journal of Emergency Medicine

11. A tool to assess risk of de novo opioid abuse or dependence. (PubMed)

A tool to assess risk of de novo opioid abuse or dependence. Determining risk factors for opioid abuse or dependence will help clinicians practice informed prescribing and may help mitigate opioid abuse or dependence. The purpose of this study is to identify variables predicting opioid abuse or dependence.A retrospective cohort study using de-identified integrated pharmacy and medical claims was performed between October 2009 and September 2013. Patients with at least 1 opioid prescription (...) claim during the index period (index claim) were identified. We ascertained risk factors using data from 12 months before the index claim (pre-period) and captured abuse or dependency diagnosis using data from 12 months after the index claim (postperiod). We included continuously eligible (pre- and postperiod) commercially insured patients aged 18 years or older. We excluded patients with cancer, residence in a long-term care facility, or a previous diagnosis of opioid abuse or dependence

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2016 American Journal of Medicine

12. Opioid Risk Tool

Opioid Risk Tool Opioid Risk Tool Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Opioid Risk Tool Opioid Risk Tool Aka: Opioid Risk (...) Score 5: Prescription Drugs Psychological Conditions Score 2: , OCD, or Score 1: Other factors Score 1: Age 16 to 45 years old Score 3: History of preadolescent sexual abuse V. Interpretation Score 0-3: Low misuse risk Score 4-7: Moderate misuse risk Score >7: High misuse risk VI. References Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Opioid Risk Tool." Click on the image (or right click) to open the source website in a new

2018 FP Notebook

13. Nerve-ous About Opioids? Treatment of neuropathic pain with opioids

Nerve-ous About Opioids? Treatment of neuropathic pain with opioids Tools for Practice is proudly sponsored by the Alberta College of Family Physicians (ACFP). ACFP is a provincial, professional voluntary organization, representing more than 4,800 family physicians, family medicine residents, and medical students in Alberta. Established over sixty years ago, the ACFP strives for excellence in family practice through advocacy, continuing medical education and primary care research. www.acfp.ca (...) June 18, 2018 Nerve-ous About Opioids? Treatment of neuropathic pain with opioids Clinical Question: What are the risks and benefits of opioids for neuropathic pain? Bottom Line: Compared to placebo, high-dose opioids moderately (at least 30%) reduce pain for an additional 1 in every 5-8 people over 4-12 weeks. Opioid-related adverse events lead to discontinuation for 1 in every 11-12 people over placebo. Other medications (like tricyclic antidepressants, gabapentin/pregabalin, and duloxetine

2018 Tools for Practice

14. Prediction Model for Two-Year Risk of Opioid Overdose Among Patients Prescribed Chronic Opioid Therapy. (PubMed)

Prediction Model for Two-Year Risk of Opioid Overdose Among Patients Prescribed Chronic Opioid Therapy. Naloxone is a life-saving opioid antagonist. Chronic pain guidelines recommend that physicians co-prescribe naloxone to patients at high risk for opioid overdose. However, clinical tools to efficiently identify patients who could benefit from naloxone are lacking.To develop and validate an overdose predictive model which could be used in primary care settings to assess the need (...) calibration, with sensitivity and specificity of 82.2% and 49.5%, respectively.Among patients on chronic opioid therapy, the predictive model identified 66-82% of all subsequent opioid overdoses. This model is an efficient screening tool to identify patients who could benefit from naloxone to prevent overdose deaths. Population differences across the two sites limited calibration in the validation site.

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2018 Journal of General Internal Medicine

15. Opioid Use and Opioid Use Disorder in Pregnancy

, it is essential that screening be universal. Routine screening should rely on validated screening tools, such as questionnaires, including 4Ps, NIDA Quick Screen, and CRAFFT (for women 26 years or younger). For chronic pain, practice goals include strategies to avoid or minimize the use of opioids for pain management, highlighting alternative pain therapies such as nonpharmacologic (eg, exercise, physical therapy, behavioral approaches), and nonopioid pharmacologic treatments. For pregnant women (...) to meet the clinical needs of the patient’s particular situation. Before prescribing opioids for their patients, obstetrician–gynecologists and other health care providers should ensure that opioids are appropriately indicated; discuss the risks and benefits of opioid use and review treatment goals; and take a thorough history of substance use and review the Prescription Drug Monitoring Program to determine whether patients have received prior opioid prescriptions. Breastfeeding should be encouraged

2017 American College of Obstetricians and Gynecologists

16. Attitudes Toward Opioids and Risk of Misuse/Abuse in Patients with Chronic Noncancer Pain Receiving Long-term Opioid Therapy. (PubMed)

to the invitation.We used four questionnaires: demographic questionnaire, the Drug Attitude Inventory Modified (DAI-M), the Opioid Risk Tool (ORT), and the Screening Tool for Addiction Risk (STAR). All questionnaires were administered in their validated French version.Three hundred seventy patients completed questionnaires. The response rate was 79.26%. Of those who responded, 61.62% women and 38.38% men, the mean age was 57 years. The patients had been treated with LtOT for an average of 6.31 years (...) Attitudes Toward Opioids and Risk of Misuse/Abuse in Patients with Chronic Noncancer Pain Receiving Long-term Opioid Therapy. To determine the attitudes of patients toward long-term opioid therapy (LtOT) and the potential risk of misuse/abuse in patients with chronic noncancer pain (CNCP).Prospective, descriptive epidemiological study.Multidisciplinary tertiary care pain center within the Montreal University Health Center.Patients who had had at least one visit at least one year prior

2017 Pain Medicine

17. A New Tool to Tackle the Opioid Epidemic: Description, Utility, and Results from the Maine Diversion Alert Program. (PubMed)

A New Tool to Tackle the Opioid Epidemic: Description, Utility, and Results from the Maine Diversion Alert Program. The opioid epidemic continues to impact the United States, and new strategies are needed to combat this epidemic. The objective of this study was to analyze 2015 drug arrest data from Maine's Diversion Alert (DA) program (diversionalert.org), compare arrest data between the first quarters of 2015 and 2016, and provide an analysis of the sex differences in the arrests as well (...) as information about DA use.This was a population-based descriptive study using data from the Maine DA program. The study population consisted of persons arrested for prescription, nonprescription, or illicit drugs.DA database.The DA program addresses Maine's prescription drug abuse epidemic with innovative resources that provide access to drug arrest data for health care providers to identify and respond to patients at risk for overdose, those engaged in illegal prescription drug distribution, and those who

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2017 Pharmacotherapy

18. A Novel Chronic Opioid Monitoring Tool to Assess Prescription Drug Steady State Levels in Oral Fluid. (PubMed)

A Novel Chronic Opioid Monitoring Tool to Assess Prescription Drug Steady State Levels in Oral Fluid. Interpretation limitations of urine drug testing and the invasiveness of blood toxicology have motivated the desire for the development of simpler methods to assess biologically active drug levels on an individualized patient basis. Oral fluid is a matrix well-suited for the challenge because collections are based on simple noninvasive procedures and drug concentrations better correlate (...) samples. This study supports novel application of basic pharmacokinetic knowledge to the pain management industry, simplifying and improving individualized drug monitoring and risk assessment through the use of oral fluid drug testing. Many benefits of established therapeutic drug monitoring in plasma can be realized in oral fluid for patients chronically prescribed oxycodone at steady state.© 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail

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2017 Pain Medicine

19. Using m-health tools to reduce the misuse of opioid pain relievers. (PubMed)

Using m-health tools to reduce the misuse of opioid pain relievers. Emergency department (ED) patients are among the many groups at risk for prescription drug overdose. There is limited research on how best to communicate with ED patients about options for pain management and the risks of opioids. The aim of this study is to pilot test a web-based, patient-centred educational programme that encourages the patient to have an informed discussion about pain medication options with their ED (...) are, assess the patient's risk factors for opioid-related adverse effects, and produce a tailored report that patients are encouraged to share with their doctor. Data are collected through surveys at three time points during the ED encounter (baseline, immediately after the intervention and just before discharge), and at a 6-week follow-up survey. The primary outcomes are whether the patient prefers an opioid pain reliever (OPR) and whether the patient takes an OPR.We hope this programme will facilitate

2017 Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention Controlled trial quality: uncertain

20. Effectiveness of policy and risk targeting for opioid-related risk mitigation: a randomised programme evaluation with stepped-wedge design. (PubMed)

in treating patients and to ensure responsible prescribing practices. The Stratification Tool for Opioid Risk Mitigation (STORM) is a web-based dashboard that prioritises review of VHA patients receiving opioids based on their risk. The VHA Partnered Evidence-based Policy Resource Center is coordinating a multiyear evaluation of STORM and aspects of the VHA policy that mandate case review of patients identified by STORM as very high risk.This stepped-wedge cluster randomised controlled trial will test two (...) Effectiveness of policy and risk targeting for opioid-related risk mitigation: a randomised programme evaluation with stepped-wedge design. There is an epidemic of opioid use related to adverse events and deaths in the USA. The rates of chronic pain, mental illness and substance use disorder are higher at the Veterans Health Administration (VHA) compared with the general US population. The 2016 Comprehensive Addiction and Recovery Act requires the VHA to improve opioid therapy strategies

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2018 BMJ open Controlled trial quality: uncertain

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