Screening Patients for Opioid Risk

The narrow therapeutic index associated with most analgesic opioids creates a high degree of risk, obliging caution in patient selection; this chapter describes screening practices. More attention is due to the use of opioid therapy for chronic non-cancer pain as episodes of respiratory arrest increase. Universal precautions are recommended for all patients. Before and throughout treatment, selected tools assessing risk and misuse should be employed. Increased access to the opioid antagonist naloxone has followed the increase in opioid poisoning deaths; the Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (RIOSORD) helps determine the likelihood of an opioid overdose, serving to select candidates for at-home naloxone access. Urine drug testing aids treatment plan adherence. Tables include: a comparison of screening tools for risk stratification; a comparison of tools for assessment of opioid misuse; the scoring procedure for the RIOSORD; and a list of risk classes with predicted probabilities.