Revised Opioid Risk Tool (ORT-OUD)
Revised Opioid Risk Tool for opioid use disorder (OUD) in chronic non-cancer pain on long-term opioids: 9 yes/no items, 1 point each (0–9) — the original ORT without its sex weighting and sexual-abuse item. Score ≥ 3 = high risk.
Score interpretation
ORT-OUD 0–2 — low risk of opioid use disorder (negative predictive value 91% in the testing sample; Cheatle 2019).
→ Standard opioid prescribing protocols; routine monitoring; urine drug screens periodically; reassess if dose escalation needed
ORT-OUD ≥ 3 — high risk of opioid use disorder (sensitivity 85%, specificity 85%, positive predictive value 76%; Cheatle 2019).
→ Addiction medicine or pain medicine co-management before initiating opioids; if already prescribed, review the need and consider tapering to non-opioid analgesia; naloxone co-prescription; close monitoring
Interpretation bands for the ORT-OUD. Apply clinical judgement and local guidance.
References
- Cheatle MD, Compton PA, Dhingra L, Wasser TE, O'Brien CP. Development of the Revised Opioid Risk Tool to Predict Opioid Use Disorder in Patients with Chronic Nonmalignant Pain. J Pain. 2019;20(7):842–851.
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.