Patients prescribed opioid medications for acute and chronic pain, with or without a history of substance abuse are at risk for developing problematic usage including misuse, abuse, and addiction.
Standard opioid management includes monitoring for compliance, such as the use of urine screens, checking state prescription monitoring program databases, and close clinical monitoring. The small percentage of patients that develop an opioid use disorder need comprehensive medication and behavioral health interventions, including:
- Discontinuing the offending opioid medication
- Behavioral therapy
- Balancing and maximizing pain management needs while still treating opioid use disorder
- Preventing further harm
A number of validated assessment tools may be useful and helping clinicians assess potential risk for aberrant behaviors and current misuse of medications for those patients placed on opioids for chronic pain.
Assessment tools are recommended by the CDC as one method in helping to better understand a patient’s risk for misuse and in turn decrease the chances of misuse, abuse, and addiction to opioids. The Opioid Risk Tool (ORT) is a self-report screening that assesses an individual’s risk for aberrant behavior and queries patients on:
- Personal or family history of substance abuse
- Psychological disease
- History of preadolescent sexual abuse
Multiple aberrant behaviors may be an early sign a patient is struggling with misuse of opioids and/or has developed an opioid use disorder.
For those patients already using opioids as part of a treatment plan for pain, the Current Opioid Misuse Measure (COMM) assesses six key areas that may represent aberrant medication-related behaviors including:
- Signs and symptoms of intoxication
- Emotional volatility
- Evidence of poor response to medications
- Healthcare use patterns
- Problematic medication behaviors
This tool can be used as an initial assessment to more formal work up for addiction.1