Matched clinical terms: tool, tool — may affect guidance relevant to Opioid Risk Tool.
Opioid Risk Tool (ORT)
Opioid Risk Tool: Screen for aberrant use behaviors in chronic opioid therapy.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Risk stratification for aberrant opioid use behaviors
Initial screening before opioid prescription in chronic pain
Identification of patients requiring closer monitoring
Support for shared decision-making in opioid therapy
Section 2
Formula & Logic
Scoring Components
Family history of drug abuse
Personal history of drug abuse
Age (younger = higher risk)
History of preadolescent sexual abuse
Psychological disease history
Risk Categories
Low risk
Score 0–3
Moderate risk
Score 4–7
High risk
Score 8+
Section 3
Pearls/Pitfalls
Key Advantages
Simple 5-item screening tool
Validated for predicting aberrant use behaviors
Helps standardize risk assessment conversations
Known Limitations
Moderate sensitivity; misses some high-risk patients
Does not capture all relevant risk factors
Performance varies across populations
Last Comprehensive Review: 2026
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Risk stratification for patients being considered for chronic opioid therapy
Screening for personal and family history of substance abuse
Clinician-patient discussions regarding safety and monitoring intensity
Part of a comprehensive opioid management/compliance strategy
Section 2
Formula & Logic
Scoring Logic
The ORT assesses 5 domains: (1) Family History, (2) Personal History, (3) Age, (4) Preadolescent Sexual Abuse, and (5) Psychological Disease. Note that point weights differ by gender for some items.
Risk Stratification
0–3 points
Low Risk — 6% risk of aberrant behavior
4–7 points
Moderate Risk — 28% risk
≥ 8 points
High Risk — 91% risk
Section 3
Evidence Appraisal
Validation
Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool.
Webster LR et al. • Pain Med.. 2005;6(6):432-42. Established the strong predictive validity of the ORT for identifies patients at high risk.
