Opioid Risk Tool (ORT)
Predicts risk of aberrant drug-related behaviour in patients prescribed opioids for chronic pain. Scored separately for male and female patients.
Score interpretation
ORT 0–3 — low risk; in the validation study 17 of 18 low-risk patients (94%) showed no aberrant drug-related behaviour.
→ Standard monitoring with routine follow-up and urine drug screening.
ORT 4–7 — moderate risk of aberrant drug-related behaviour.
→ Enhanced monitoring: frequent follow-up, urine drug screens, pill counts, prescription drug monitoring.
ORT ≥ 8 — high risk; 40 of 44 high-risk patients (91%) showed aberrant drug-related behaviour within 12 months (Webster 2005).
→ Specialist pain/addiction referral before prescribing. Structured opioid therapy agreement. Consider non-opioid alternatives.
Interpretation bands for the ORT. Apply clinical judgement and local guidance.
References
- Webster LR, Webster RM. Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool. Pain Med. 2005;6(6):432-442.
Related
Curated clinical cross-links plus same-class fallbacks.
- Fentanyl Transdermal Patch (Elderly Chronic Pain) · Opioid Analgesic — Transdermal Patch
- Morphine Slow-Release (Elderly Chronic Pain) · Opioid Analgesic — Modified-Release Oral
- Morphine (Orthopaedic Acute Pain) · Opioid Analgesic — Strong
- Oxycodone (Orthopaedic Post-operative Pain) · Opioid Analgesic — Strong
- Ketamine (Sub-anaesthetic — Orthopaedic Pain) · NMDA Receptor Antagonist — Opioid-Sparing Analgesic
- Codeine Phosphate (Orthopaedic — Mild-Moderate Pain) · Opioid Analgesic — Weak (Prodrug)
- Acute Behavioural Disturbance / Rapid Tranquillisation · RCEM 2022; RCPsych 2022; NICE NG10
- Self-Harm Presentation · NICE NG225 (2022)
- Capacity Assessment (Mental Capacity Act) · MCA 2005; Code of Practice
- Acute Psychosis Management · NICE CG178 2014
- Depression Management · NICE CG90 2022
- Lithium Therapy Monitoring · NICE CG185
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.