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Opioid Risk Tool (ORT)

Opioid Risk Tool (ORT)
Date:
 
Patient name:
 
  Mark each box that applies Item score (female) Item score (male)
  1. Family history of substance abuse
  • Alcohol
[ ] 1 3
  • Illegal drugs
[ ] 2 3
  • Prescription drugs
[ ] 4 4
  1. Personal history of substance abuse
  • Alcohol
[ ] 3 3
  • Illegal drugs
[ ] 4 4
  • Prescription drugs
[ ] 5 5
  1. Age (mark box if 16 to 45)
  [ ] 1 1
  1. History of preadolescent sexual abuse
  [ ] 3 0
  1. Psychological disease
  • Attention deficit disorder
  • Obsessive compulsive disorder
  • Bipolar
  • Schizophrenia
[ ] 2 2
  • Depression
[ ] 1 1
  TOTAL: _____ _____
Total score risk category:
  • Low risk: 0 to 3
  • Moderate risk: 4 to 7
  • High risk: ≥8
Reproduced from: Webster LR, Webster RM. Predicting aberrant behaviors in opioid-treated patients: Preliminary validation of the opioid risk tool. Pain Medicine 2005; 6(6):432-442, by permission of Oxford University Press on behalf of the American Academy of Pain Medicine, and Lynn R. Webster, MD, author of "The Painful Truth: What Pain is Really Like and Why it Matters to Each of Us."
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