• Opioid Risk Tool (ORT)

  • Visit date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Gender identity is used to score the tool apporiately. If Other is selected, the tool takes the maximum of the female and male scores.

  • Gender identity

  • The following two questions are not scored and are not part of the actual ORT. They were taken from a different source.

  • In the last year, have you ever drunk or used drugs more than you meant to?
  • Have you felt you wanted or needed to cut down on your drinking or drug use in the last year?

  • These questions contain the appropriate scoring values for females.

  • Do you have a family history of substance abuse of alcohol?
  • Do you have a family history of substance abuse of illegal drugs?

  • These questions contain the appropriate scoring values for males.

  • Do you have a family history of substance abuse of alcohol?
  • Do you have a family history of substance abuse of illegal drugs?

  • The following questions are scored the same for any gender.

  • Do you have a family history of substance abuse of prescription drugs?
  • Do you have a personal history of substance abuse of alcohol?
  • Do you have a personal history of substance abuse of illegal drugs?
  • Do you have a personal history of substance abuse of prescription drugs?
  • Is your age between 16 and 45, inclusive?

  • This question is shown only to females.

  • Do you have a personal history of preadolescent sexual abuse?

  • The following questions are scored the same for any gender.

  • Have you been diagnosed with ADD, OCD, bipolar disorder, or schizophrenia?
  • Have you been diagnosed with depression?

  • This tool should be administered to patients upon an initial visit prior to beginning opioid therapy for pain management. A score of 3 or lower indicates low risk for future opioid abuse, a score of 4 to 7 indicates moderate risk for opioid abuse, and a score of 8 or higher indicates a high risk for opioid abuse.

    Questionnaire developed by Lynn R. Webster, MD to assess risk of opioid addiction.

    The Opioid Risk Tool (ORT) is a brief, self-report 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 behavior. The ORT can be administered and scored in less than 1 minute and has been validated in both male and female patients, but not in non-pain populations.

    Webster, L. R., & Webster, R. M. (2005). Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool. Pain medicine (Malden, Mass.), 6(6), 432–442. https://doi.org/10.1111/j.1526-4637.2005.00072.x

     

  • Have there been any changes to your medications?
  • Do you have access to your Patient Portal account?
  • Should be Empty: