The Opioid Risk Tool (ORT) was designed by researchers studying chronic pain adult patients. While there are many other risk factors associated with OUD, this is a helpful benchmark to understand some of your risks as you consider opioid treatment.
Your personal risk of addiction is incredibly complicated, and researchers are always looking for better ways to quantify it. While much of your risk stems from your environment, a surprisingly large portion of it is purely genetic. This is why the ORT measures personal and family information.
Importantly, a high score does not mean that you should never undergo opioid therapy, and providers should never rely on this tool to make complex medical decisions. The ORT specifically predicts the probability of "aberrant drug activity" over the following year. High scores are simply a helpful reminder to tread carefully, as these unique factors may make patients particularly vulnerable.
Here's what these unique factors may point to:
Research has found strong co-occurrence of substance abuse. That is, if you struggle with one substance (like alcohol), you are statistically more likely to struggle with others (like opioids).
You may also notice that these scores are slightly weighted toward men. The data show that men are more likely to abuse opioids than women, and some research suggests that the co-occurrence of substance abuse may be stronger in men than women.
Much of addiction is genetic. While in-depth genetic testing can provide a much more granular analysis of one's OUD risk, family history offers a rough estimate of a given individual's genetic risks.
Traumatic experiences can powerfully increase one's risk of future substance misuse. For the sake of brevity, this test focuses on the most common source of PTSD for individuals, sexual abuse.
This question only increases the risk score for women, because almost all of the research linking sexual abuse to substance abuse focuses on women. While sexual abuse almost certainly increases the risk of opioid misuse among men as well, the authors of this tool did not find enough credible research to include this assumption in the model.
Research shows strong links between many mental disorders and substance misuse. This is sometimes the result of chemical imbalances in the brain--such as low serotonin or dopamine--that can be temporarily altered by opioids.
This tool was adapted from the research of Lynn R. Webster, MD and Rebecca M. Webster. The self-reported score predicted aberrant behaviors with a c-statistic of 0.82 (male) and 0.85 (female). You can learn more about their study here.
