902 - Opioid risk tool (ORT) vs pain psychology evaluation for aberrant opioid use prediction

Objectives: Various validated risk assessment tools have been published to predict the likelihood that a specific patient will develop non-adherence behaviors with prescribed opioid therapy. However, systematic reviews evaluating the predictive validity of these tools have revealed significant limitations. This project reviewed the utility and effectiveness of formal pain psychology opioid risk assessments compare to standard opioid risk tool (ORT) on noncompliance and adherent behaviors on patients managed on opioids.

Design: Charts were reviewed on opioid managed patients that were referred and transferred from the primary care ser ice. All patients were screened with ORT at the initial visit and by a pain psychologist within 1 month of the initial evaluation. Risk Assessments were scored as Low, Moderate, or High. Patients were evaluated monthly, and compliance monitoring included urine drug screens (UDS). Inappropriate results, such as presence of illegal substance and non-prescribed opioids and benzodiazepines, were considered as aberrant behavior.

Results: A total of 89 patients over 4 months, were included and monitored for 6 months. 7 patients were screened as High risk by the pain psychologist. Of the 7, 4 (57%) exhibited aberrant behavior on UDS within 6 months. Of the 7 patients, only 1 screened as High on ORT, while the rest screened as Low. Of the 32 that were considered Moderate risk by pain psychologist, 15 (46.8%) had inappropriate UDS within 6 months. Of the 15, 6 scored as Moderate rsk and 2 as High on ORT. Of the 50 Low risk patients per pain psychologist, 6 (12%) had inappropriate UDS. all 6 were Low risk on ORT.

Conclusions: Formal pain psychology evaluation for screening may be more accurate and valuable in predicting aberrant opioid use, particularly when compared to ORT. Patients with screening scores of Moderate and High risks by pain psychology were significantly more likely to display aberrant use.