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Opioid Risk Tool

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1. Measurement Properties of Tools Used to Measure Sexual Risk Behaviours, Illicit drug use and Needle Risk Behaviours among Opioid Use Disorder (OUD) during Methadone Treatment: A Systematic Review.

Measurement Properties of Tools Used to Measure Sexual Risk Behaviours, Illicit drug use and Needle Risk Behaviours among Opioid Use Disorder (OUD) during Methadone Treatment: A Systematic Review. Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears (...) is not possible, data will be reported through a descriptive summary. ">Planned approach If a meta-analysis is planned , please specify the following:"> Example: number of metastases: standardized mean difference; incidence of metastasis: risk ratio. ">Effect measure The random-effects model is the typical model of choice for pre-clinical meta-analyses. This is because in the fixed-effect model, it is assumed that the differences in observed effect between studies is solely due to sampling error (i.e

2020 PROSPERO

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. (Abstract)

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). Full Text available with Trip Pro

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

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

5. Re-assessing the Validity of the Opioid Risk Tool in a Tertiary Academic Pain Management Center Population. Full Text available with Trip Pro

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. Screening in Trauma for Opioid Misuse Prevention (STOMP): study protocol for the development of an opioid risk screening tool for victims of injury Full Text available with Trip Pro

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

2017 Addiction science & clinical practice

7. Do the use of opioid screening tools and interventions for minimising opioid misuse reduce morbidity and mortality in cancer patients requiring opioid analgesia?- A systematic review.

Do the use of opioid screening tools and interventions for minimising opioid misuse reduce morbidity and mortality in cancer patients requiring opioid analgesia?- A systematic review. Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility (...) is not possible, data will be reported through a descriptive summary. ">Planned approach If a meta-analysis is planned , please specify the following:"> Example: number of metastases: standardized mean difference; incidence of metastasis: risk ratio. ">Effect measure The random-effects model is the typical model of choice for pre-clinical meta-analyses. This is because in the fixed-effect model, it is assumed that the differences in observed effect between studies is solely due to sampling error (i.e

2020 PROSPERO

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’ Full Text available with Trip Pro

, 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. Canadian guidelines on opioid use disorder among older adults

) This study also noted a shift from illicit drugs to those obtained by prescription as the primary type of opioid used. Additionally, when compared to their younger counterparts, older US veterans with OUD have higher rates of comorbid mood disorder, post-traumatic stress disorder, hepatitis C, human immunodeficiency virus, and chronic pain, including neuropathy, which has notably increased the cost of care. (23) The purpose of this article is to outline the issues facing older adults with, or at risk (...) four rated OUD guidelines focused on adults in general (not just older adults) published in the last 10 years. (29-32) We chose the US Veterans’ Affairs and Department of Defense’s guideline (2015) as the best rated guideline to use as a starting point, per the AGREE II tool. We also relied on elements of the Canadian Clinical Practice Guideline for Opioid Use Disorder for its applicability to our local context. (32) Recommendations from less robust guidelines and clini- cal practice tips on OUD

2020 CPG Infobase

10. Impact of Medical Marijuana Legalization on Opioid Use, Chronic Opioid Use, and High-risk Opioid Use. Full Text available with Trip Pro

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

11. 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

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

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

13. Managing opioid use disorder in primary care: PEER simplified guideline

of 0.2) . 22 The COMM (Current Opioid Misuse Measure) might also be reasonable in helping diagnose OUD, but it is too long for regular use in primary care. 22 Others tools (eg, SOAPP [Screener and Opioid Assessment for Patients with Pain], ORT [Opioid Risk Tool]) have not been compared with the DSM criteria, meaning their validity in an OUD population is unknown. 22 Based on this limited evidence, clinicians could con- sider the use of a simple tool such as the POMI if they require assistance (...) edition, criteria; however, the definition has changed over time. Given this inconsistent definition and differing study designs, a reasonable estimate of OUD risk after initial opioid prescription might be 4.7%, recognizing that stud- ies range broadly from 0% to 34%. 7-14 In response to the number of Canadians with OUD and the number of opioid- related deaths, the federal government launched a Canadian drugs and substances strategy. 15,16 In line with this strategy, national methadone prescribing

2019 CPG Infobase

14. Canadian guidelines on opioid use disorder among older adults

, or that the cost or burden of the proposed intervention may not be justified . (Adapted from Guyatt et al, 2008)6 Canadian Guidelines on Opioid Use Disorder Among Older Adults QUESTION A: In older adults, what measures can reduce the risk of developing an OUD? RECOMMENDATION #1: In order to avoid the risk of developing an OUD, older adults with acute pain in whom opioids are being considered should receive the lowest effective dose of the least potent immediate release opioid for a duration of = 3 days (...) and rarely > 7 days. [GRADE Quality: Moderate; Strength: Strong] RECOMMENDATION #2: In most circumstances, avoid prescribing opioids for older adults with CNCP . For severe pain that is not responsive to non- opioid therapy in patients without a history of substance use disorder and without active mental illness, a trial of opioid treatment may be considered. Consider obtaining a second opinion before prescribing long-term opioid therapy. After explaining the risks and benefits to the patient, prescribe

2019 CPG Infobase

15. Naloxone nasal spray (Nyxoid) for opioid overdose

is part of emergency rescue treatment for known or suspected opioid overdose It can be administered via nasal spray or intramuscular injection and takes effect 2 to 5 minutes later. Naloxone nasal spray (Nyxoid) is PBS-listed as an unrestricted General Schedule listing PBS listing is expected to increase use of naloxone in the community. Naloxone nasal spray has advantages over naloxone injectables Advantages include ease of administration, minimal training requirements and no risk of needle-stick (...) injury. Naloxone nasal spray is recommended for patients at increased risk of opioid overdose or people who are likely to witness opioid overdose When prescribing opioids for patients with increased overdose risk, incorporate strategies to minimise risk including co-prescribing naloxone. Ensure naloxone nasal spray is given for opioid overdose in a timely and effective manner Provide education and training about opioid overdose and naloxone nasal spray usage to patients and carers. Evidence snapshot

2020 National Prescribing Service Limited (Australia)

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

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

17. Evidence Brief - Barriers and Facilitators to Use of Medications for Opioid Use Disorder

trends, the proportion of opioid overdoses among Veterans due to illicit opioids is increasing. Opioid overdose among Veterans increased from 14.5 per 100,000 person-years in 2010 to 21.1 per 100,000 person-years in 2016, mostly due to overdoses from heroin and synthetic opioids such as fentanyl rather than prescription opioids. This finding highlights the need for opioid risk reduction efforts beyond safer opioid prescribing in the healthcare setting. As a component of the Veterans Health (...) overdoses among Veterans due to illicit opioids is increasing. Opioid overdose among Veterans increased from 14.5 per 100,000 person- years in 2010 to 21.1 per 100,000 person-years in 2016, mostly due to overdoses from heroin and synthetic opioids such as fentanyl rather than prescription opioids. 1 This finding highlights the need for opioid risk reduction efforts beyond those aimed at increasing opioid safety in the in the healthcare setting. As a component of the Veterans Health Administration’s (VHA

2019 Veterans Affairs Evidence-based Synthesis Program Reports

18. Is Low-Dose Ketamine an Effective Alternative to Opioids for Acute Pain? Full Text available with Trip Pro

. The quality of individual trials was assessed with the Cochrane Risk of Bias Tool. Results Ketamine versus morphine for acute pain in the ED (outcome at 10 minutes). Study Sample Size Indication Ketamine Dose (mg/kg) Difference in Δ NRS Score (95% CI) Majidinejad 1 x 1 Majidinejad, S., Esmailian, M., and Emadi, M. Comparison of intravenous ketamine with morphine in pain relief of long bone fractures: a double blind randomized clinical trial. Emerg (Tehran) . 2014 ; 2 : 77–80 126 Long bone fracture 0.5 (...) in the emergency department: a randomized controlled trial. Ann Emerg Med . 2015 ; 66 : 222–229.e221 Alternatives to opioid analgesia have been sought because of the risk of adverse events such as hypoxia and potential for opioid misuse. This systematic review and meta-analysis found that in ED patients with acute pain, low-dose intravenous ketamine provided pain relief at 10 minutes comparable to that of intravenous morphine at 0.1 mg/kg. This is consistent with results of previous reviews using broader

2019 Annals of Emergency Medicine Systematic Review Snapshots

19. Opioid Treatments for Chronic Pain

unavailable or too limited to reach reliable conclusions. New evidence on the accuracy of risk prediction instruments was consistent with the 2014 AHRQ report, which found highly inconsistent estimates of diagnostic accuracy, methodological limitations and few studies of risk assessment instruments other than the Opioid Risk Tool (ORT) and Screening and Opioid Assessment for Patients with Pain-Revised (SOAPP-R). Studies on the accuracy of risk instruments for identifying aberrant behavior in patients (...) , Pharm.D. Judith Turner, Ph.D. Ian Blazina, M.P.H. Brian Chan, M.D. Ximena Levander, M.D. Marian McDonagh, Pharm.D. Shelley Selph, M.D., M.P.H. Rongwei Fu, Ph.D. Miranda Pappas, M.A. AHRQ Publication No. 20-EHC011 April 2020 ii Key Messages Purpose of Review To assess the effectiveness and harms of opioid therapy for chronic noncancer pain, alternative opioid dosing strategies, and risk mitigation strategies Key Messages • Opioids are associated with small improvements versus placebo in pain

2020 Effective Health Care Program (AHRQ)

20. Can prescribers avoid contributing to opioid use disorder?

strategies to identify low versus high-risk pa- tients have not been reviewed critically. Primary care com- monly applies the “Opioid Risk Tool.” 14 A 2019 systematic review of strategies to identify patients at risk of developing OUD suggests caution about applying risk estimation to clinical decisions. 15 For people with pain who are not already using opioids, all screening tools (including the “Opioid Risk Tool”) are based on lower quality studies or demonstrate extremely poor diagnostic performance (...) ) can increase the prevalence of OUD in people with pain. Anticipating and preventing this could reduce premature deaths and serious morbidity. To avoid engendering OUD, prescribers should adopt universal precautions for opioid- naïve patients and communicate important new evidence: • Long-term opioid therapy is unlikely to benefit most people with chronic non-cancer pain. • There is no valid tool, nor validated way to identify patients at low risk for OUD when starting opioids. • Reserve opioids

2020 Therapeutics Letter

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