Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
J Pain. 2019 Jul;20(7):842-851. doi: 10.1016/j.jpain.2019.01.011. Epub 2019 Jan 26.
The Opioid Risk Tool (ORT) is a commonly used measure of risk of aberrant drug-related behaviors in patients with chronic pain prescribed opioid therapy. In this study, the discriminant predictive validity of the ORT was evaluated in a unique cohort of patients with chronic nonmalignant pain (CNMP) on long-term opioid therapy who displayed no evidence of developing an opioid use disorder (OUD) and a sample of patients with CNMP who developed an OUD after commencing opioid therapy. Results revealed that the original ORT was able to discriminate between patients with and without OUDs (odds ratio = 1.624; 95% confidence interval [CI] = 1.539-1.715, P < .001). A weighted ORT eliminating the gender-specific history of preadolescent sexual abuse item revealed comparable results (odds ratio = 1.648, 95% CI = 1.539-1.742, P < .001). A revised unweighted ORT removing the history of preadolescent sexual abuse item was notably superior in predicting the development of OUD in patients with CNMP on long-term opioid therapy (odds ratio = 3.085; 95% CI = 2.725-3.493; P < .001) with high specificity (.851; 95% CI = .811-.885), sensitivity (.854; 95% CI = .799-.898), positive predictive value (.757; 95% CI = .709-.799), and negative predictive value (.914; 95% CI = .885-.937). Perspective: The revised ORT is the first tool developed on a unique cohort to predict the risk of developing an OUD in patients with CNMP receiving opioid therapy, as opposed to aberrant drug-related behaviors that can reflect a number of other issues. The revised ORT has clinical usefulness in providing clinicians a simple, validated method to rapidly screen for the risk of developing OUD in patients on or being considered for opioid therapy.
阿片类药物风险工具（ORT）是一种常用于衡量慢性疼痛患者接受阿片类药物治疗时出现异常药物相关行为风险的指标。在这项研究中，我们评估了 ORT 在一个独特的慢性非恶性疼痛（CNMP）患者队列中的判别预测有效性，这些患者长期接受阿片类药物治疗，但没有出现阿片类药物使用障碍（OUD）的证据，以及一组在开始阿片类药物治疗后出现 OUD 的 CNMP 患者。结果表明，原始 ORT 能够区分有无 OUD 的患者（优势比=1.624；95%置信区间[CI]为 1.539-1.715，P<.001）。消除了性别特异性青春期前性虐待史项目的加权 ORT 显示出类似的结果（优势比=1.648，95%CI 为 1.539-1.742，P<.001）。一个修订后的非加权 ORT ，去除了青春期前性虐待史项目，在预测长期接受阿片类药物治疗的 CNMP 患者中 OUD 的发展方面表现更为优越（优势比=3.085；95%CI 为 2.725-3.493；P<.001），具有较高的特异性（0.851；95%CI 为 0.811-0.885）、敏感性（0.854；95%CI 为 0.799-0.898）、阳性预测值（0.757；95%CI 为 0.709-0.799）和阴性预测值（0.914；95%CI 为 0.885-0.937）。观点：修订后的 ORT 是第一个在独特队列上开发的工具，用于预测接受阿片类药物治疗的 CNMP 患者发生 OUD 的风险，而不是反映许多其他问题的异常药物相关行为。修订后的 ORT 在为临床医生提供一种简单、经过验证的方法来快速筛查接受或考虑接受阿片类药物治疗的患者发生 OUD 的风险方面具有临床实用性。
