Opioid Risk Tool (ORT)

The Opioid Risk Tool (ORT) is a brief, self-report or clinician rated screening tool designed for use with adult patients in primary care settings to assess risk for opioid abuse among individuals prescribed opioids for treatment of chronic pain. Patients categorized as high-risk are at increased likelihood of future abusive drug-related behaviours. This tool is best administered to patients upon an initial visit prior to beginning opioid therapy, and can inform the risk/benefit decisions around prescribing opioid medication.

The ORT asks questions about the following risk factors based on scientific literature: personal and family history of substance abuse; age; history of preadolescent sexual abuse; and certain psychological diseases.

Validity and Reliability

In the initial validation research by Webster (2005) administered the ORT to 85 patients treated with opioids at pain clinics. For those patients with a risk category of low, 17 out of 18 (94.4%) did not display an aberrant behaviour. For those patients with a risk category of high, 40 out of 44 (90.9%) did display an aberrant behaviour. The ORT displayed excellent discrimination for both the male (c = 0.82) and the female (c = 0.85) prognostic models. Among patients prescribed opioids for chronic pain, the ORT exhibited a high degree of sensitivity and specificity for determining which individuals are at risk for opioid-related, aberrant behaviours.

Scoring and Interpretation

Scores range from 0 to 26. The scores are categorized into three risk categories.

– Low Risk= Scores 0-3
– Moderate Risk = scores 4 – 7
– High risk = Scores 8 or more

According to the validation sample (Webster, 2005) patients in the low risk category have a 5.6% chance of developing one or more aberrant behaviour when prescribed opioids. The moderate risk category had a risk of 28% while the high risk category had a risk of 91%. Note that these percentages are not direct measures of risk of opioid abuse or dependence, but rather aberrant behaviours (which are known to be associated with abuse and dependence). Aberrant behaviours are defined as:

-Used additional opioids than those prescribed
-Used additional opioids than those prescribed more than once
-Forged prescription
-Sold prescription
-Admitted to seeking euphoria from opioids
-Admitted to wanting opioids for anxiety
-Overdose and death
-Injected drug
-Abnormal urine/blood screen
-Abnormal urine/blood screen positive for 2 or more substances
-Solicited opioids from other providers
-Unauthorized ER visits
-Concurrent abuse of alcohol
-Unauthorized dose escalation


Webster LR. Predicting aberrant behaviors in opioid-treated patients: Preliminary validation of the opioid risk tool. Pain Medicine. 2005;6(6):432-442. Used with permission.