[{"data":1,"prerenderedAt":399},["ShallowReactive",2],{"assessment-opioid-risk-tool":3,"assessments-related-opioid-risk-tool":376},{"id":4,"title":5,"body":6,"category":305,"categoryTitle":306,"clinicalCitations":307,"copyright":323,"description":324,"downloadLink":305,"extension":325,"faqs":326,"featured":342,"firstPublished":343,"i18nReady":342,"icon":305,"inHiBoop":344,"interpreter":345,"interpreterExempt":305,"lastReviewed":361,"meta":362,"navigation":363,"path":364,"permissionsNote":365,"published":363,"recommendedFrequency":305,"relatedCodes":305,"relatedConditions":305,"relevantSpecialty":366,"reviewedBy":305,"seo":369,"slug":370,"status":371,"stem":372,"summary":373,"takeaways":305,"timeline":305,"type":374,"usedToDiagnose":305,"__hash__":375},"assessments\u002Fassessments\u002Fopioid-risk-tool.md","Opioid Risk Tool (ORT and ORT-OUD): Scoring and Cutoffs",{"type":7,"value":8,"toc":294},"minimark",[9,22,27,30,52,75,79,82,108,111,115,124,136,180,183,187,224,228,275,279],[10,11,12,13,17,18,21],"p",{},"The ORT (Opioid Risk Tool) is a brief screen for the risk of opioid misuse in adults with chronic pain who are on, or being considered for, opioid therapy. Webster and Webster published the original in 2005 ",[14,15],"cite-ref",{"n":16},"1","; Cheatle and colleagues published a revised version, the ORT-OUD, in 2019 to predict opioid use disorder specifically ",[14,19],{"n":20},"2",".",[23,24,26],"h2",{"id":25},"what-does-the-ort-measure","What does the ORT measure?",[10,28,29],{},"Both versions count known risk factors for problematic opioid use. They do not measure current use or symptoms.",[31,32,33,43],"ul",{},[34,35,36,40,41,21],"li",{},[37,38,39],"strong",{},"Original ORT (2005)."," Developed to predict which people prescribed opioids for chronic pain may show opioid-related aberrant behaviours. It covers personal and family history of substance abuse, age, history of preadolescent sexual abuse, and certain psychological conditions ",[14,42],{"n":16},[34,44,45,48,49,51],{},[37,46,47],{},"ORT-OUD (2019)."," Developed to predict the more serious outcome of opioid use disorder in adults with chronic non-cancer pain on long-term opioid therapy ",[14,50],{"n":20},". Its nine yes or no items cover family history of alcohol, illegal drug and prescription drug abuse; personal history of the same three; age 16 to 45; attention deficit disorder, obsessive-compulsive disorder, bipolar disorder or schizophrenia; and depression.",[10,53,54,55,60,61,65,66,70,71,21],{},"Related risk screens for opioid therapy include the ",[56,57,59],"a",{"href":58},"\u002Fassessments\u002Fpmq\u002F","PMQ",". For broader drug use screening, see the ",[56,62,64],{"href":63},"\u002Fassessments\u002Fdast-10\u002F","DAST-10",", ",[56,67,69],{"href":68},"\u002Fassessments\u002Fassist\u002F","ASSIST"," or ",[56,72,74],{"href":73},"\u002Fassessments\u002Fcage-aid\u002F","CAGE-AID",[23,76,78],{"id":77},"how-do-you-give-the-ort","How do you give the ORT?",[10,80,81],{},"The ORT is intended for the first visit, before opioid therapy begins or continues. It can be self-completed or asked by a clinician.",[31,83,84,100],{},[34,85,86,89,90,92,93,96,97,21],{},[37,87,88],{},"Self-report vs clinician-completed."," Self-report depends on candour. Some studies found better prediction when a clinician completed the ORT or when answers were checked against the medical record ",[14,91],{"n":20}," ",[14,94],{"n":95},"3",", though in one pain centre the physician-completed ORT was not strongly predictive either ",[14,98],{"n":99},"4",[34,101,102,105,106,21],{},[37,103,104],{},"Use it with other information."," The ORT-OUD authors describe it alongside the prescription drug monitoring program and urine drug testing as part of selecting and monitoring clients for opioid therapy ",[14,107],{"n":20},[10,109,110],{},"For clinical use and educational reference only. A risk score informs the treatment plan and monitoring; it does not decide whether opioids are prescribed.",[23,112,114],{"id":113},"how-do-you-score-and-interpret-the-ort","How do you score and interpret the ORT?",[10,116,117,120,121,123],{},[37,118,119],{},"ORT-OUD."," Each yes scores 1, for a total of 0 to 9. The development study found a cutoff of 3 the best split: 0 to 2 indicates low risk and 3 or more high risk for opioid use disorder ",[14,122],{"n":20},". The score interpreter above uses these bands.",[10,125,126,129,130,132,133,135],{},[37,127,128],{},"Original ORT."," Each risk factor carries a weight from 1 to 5, and some weights differ for women and men; the preadolescent sexual abuse item is weighted for women only ",[14,131],{"n":20},". The weights are summed and banded ",[14,134],{"n":16},":",[137,138,139,152],"table",{},[140,141,142],"thead",{},[143,144,145,149],"tr",{},[146,147,148],"th",{},"Original ORT total",[146,150,151],{},"Risk of opioid-related aberrant behaviours",[153,154,155,164,172],"tbody",{},[143,156,157,161],{},[158,159,160],"td",{},"0 to 3",[158,162,163],{},"Low",[143,165,166,169],{},[158,167,168],{},"4 to 7",[158,170,171],{},"Moderate",[143,173,174,177],{},[158,175,176],{},"8 or more",[158,178,179],{},"High",[10,181,182],{},"A higher score means more risk factors, not a diagnosis. Low risk is not no risk, and monitoring continues for everyone on long-term opioid therapy.",[23,184,186],{"id":185},"psychometric-properties","Psychometric properties",[31,188,189,197,207,215],{},[34,190,191,196],{},[37,192,193,194,135],{},"Original validation ",[14,195],{"n":16}," In 185 consecutive new clients at one pain clinic, followed for 12 months, 17 of 18 (94.4%) in the low-risk group showed no aberrant behaviour and 40 of 44 (90.9%) in the high-risk group did. Discrimination was c = 0.82 for men and c = 0.85 for women.",[34,198,199,206],{},[37,200,201,202,92,204,135],{},"Replication attempts ",[14,203],{"n":95},[14,205],{"n":99}," In 225 consecutive new clients at a tertiary academic pain centre, the self-report ORT was no better than chance at predicting aberrant behaviour and the original risk categories were not supported; with medical record data added, high-risk clients were 2.5 times more likely than low-risk clients to show an aberrant behaviour. In 125 clients at another tertiary pain centre, neither the client-completed nor the physician-completed ORT strongly predicted moderate to severe aberrant behaviour.",[34,208,209,214],{},[37,210,211,212,135],{},"ORT-OUD development ",[14,213],{"n":20}," In 1,178 adults with chronic non-cancer pain on long-term opioid therapy (397 with opioid use disorder), the unweighted 9-item version outperformed the weighted original. In the validation half, the area under the curve was 0.907; in the testing half, a cutoff of 3 or more gave sensitivity 0.854, specificity 0.851, positive predictive value 0.757 and negative predictive value 0.914.",[34,216,217,223],{},[37,218,219,220,135],{},"Later case-control data ",[14,221],{"n":222},"5"," In 1,300 adults with chronic non-cancer pain (409 with opioid use disorder), models using the ORT-OUD alone showed precision of 0.91 and specificity of 0.96; adding other clinical predictors improved performance further.",[23,225,227],{"id":226},"limitations","Limitations",[31,229,230,236,246,254,266],{},[34,231,232,235],{},[37,233,234],{},"A risk screen, not a diagnosis."," Neither version diagnoses opioid use disorder or predicts outcomes for an individual with certainty.",[34,237,238,241,242,92,244,21],{},[37,239,240],{},"Mixed evidence for the original."," Later studies in tertiary pain centres did not reproduce the original ORT's accuracy or support its three risk categories ",[14,243],{"n":95},[14,245],{"n":99},[34,247,248,251,252,21],{},[37,249,250],{},"Narrow ORT-OUD sample."," The development study enrolled only white adults of European descent, for genetic study reasons, so the authors state the results cannot be generalized to other groups without replication. It was also cross-sectional ",[14,253],{"n":20},[34,255,256,259,260,92,262,92,264,21],{},[37,257,258],{},"Self-report bias."," Answers can be under-reported; record review, and in some studies clinician completion, improved prediction ",[14,261],{"n":20},[14,263],{"n":95},[14,265],{"n":99},[34,267,268,271,272,274],{},[37,269,270],{},"Outcome differences."," The original predicts aberrant drug-related behaviours, which can reflect many issues other than opioid use disorder; the ORT-OUD targets opioid use disorder itself ",[14,273],{"n":20},". Choose the version that matches the question.",[23,276,278],{"id":277},"ort-vs-ort-oud","ORT vs ORT-OUD",[10,280,281,282,286,287,289,290,21],{},"Use the ORT-OUD when the question is risk of ",[56,283,285],{"href":284},"\u002Ficd-10\u002Ff11-20-opioid-use-disorder\u002F","opioid use disorder"," before or during long-term opioid therapy; it is shorter, unweighted and the same for everyone. The original ORT remains widely cited and predicts aberrant drug-related behaviours, but its weights came from expert judgement rather than psychometric testing ",[14,288],{"n":20},". For opioid withdrawal severity, which is a different question, see the ",[56,291,293],{"href":292},"\u002Fassessments\u002Fcows\u002F","COWS",{"title":295,"searchDepth":296,"depth":296,"links":297},"",3,[298,300,301,302,303,304],{"id":25,"depth":299,"text":26},2,{"id":77,"depth":299,"text":78},{"id":113,"depth":299,"text":114},{"id":185,"depth":299,"text":186},{"id":226,"depth":299,"text":227},{"id":277,"depth":299,"text":278},null,"Substance Use",[308,311,314,317,320],{"text":309,"link":310},"Webster LR, Webster RM. Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool. Pain Med. 2005;6(6):432-442.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F16336480\u002F",{"text":312,"link":313},"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.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F30690168\u002F",{"text":315,"link":316},"Clark MR, Hurley RW, Adams MCB. Re-assessing the Validity of the Opioid Risk Tool in a Tertiary Academic Pain Management Center Population. Pain Med. 2018;19(7):1382-1395.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F29408996\u002F",{"text":318,"link":319},"Witkin LR, Diskina D, Fernandes S, Farrar JT, Ashburn MA. Usefulness of the opioid risk tool to predict aberrant drug-related behavior in patients receiving opioids for the treatment of chronic pain. J Opioid Manag. 2013;9(3):177-187.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F23771568\u002F",{"text":321,"link":322},"Davis CN, Lee Y, Cheatle MD. Prediction of opioid use disorder among patients with chronic non-cancer pain receiving long-term opioid therapy. Pain Med. 2026;27(2):136-144.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F41428450\u002F","Original ORT: Lynn R. Webster, MD (2005). ORT-OUD: developed by Cheatle MD, Compton PA, Dhingra L, Wasser TE, O'Brien CP (2019).","Opioid Risk Tool scoring guide: the original ORT (low 0-3, moderate 4-7, high 8+) and the revised 9-item ORT-OUD (0-2 low, 3+ high risk) for opioid therapy.","md",[327,330,333,336,339],{"question":328,"answer":329},"How is the Opioid Risk Tool scored?","The original ORT gives each risk factor a weight from 1 to 5, with some weights differing for women and men, and sums them: 0 to 3 is low, 4 to 7 moderate and 8 or more high risk of opioid-related aberrant behaviours. The revised ORT-OUD has 9 yes or no items worth 1 point each, so totals run 0 to 9: 0 to 2 is low and 3 or more high risk for opioid use disorder.",{"question":331,"answer":332},"What is the difference between the ORT and the ORT-OUD?","The ORT (Webster and Webster, 2005) predicts opioid-related aberrant drug-related behaviours and uses sex-specific weights. The ORT-OUD (Cheatle and colleagues, 2019) removes the preadolescent sexual abuse item, drops the weights so each item scores 0 or 1, and was developed to predict the more serious outcome of opioid use disorder in adults with chronic non-cancer pain on long-term opioid therapy.",{"question":334,"answer":335},"What does a high Opioid Risk Tool score mean?","A high score means the client has more of the risk factors linked to opioid misuse or opioid use disorder. It is not a diagnosis and does not by itself decide whether opioids are prescribed. Care teams use it to inform closer monitoring, further assessment and the treatment plan, alongside the prescription monitoring program, urine drug testing and clinical judgement.",{"question":337,"answer":338},"Who should complete the Opioid Risk Tool, and when?","It is meant for adults with chronic pain at the first visit, before opioid therapy begins or continues. The client can complete it themselves or a clinician can ask the questions. Some studies found better prediction when answers were checked against the health record or the tool was completed by a clinician, though one found the physician-completed version was not strongly predictive either.",{"question":340,"answer":341},"How accurate is the ORT-OUD?","In the 2019 development study of 1,178 adults with chronic non-cancer pain, a cutoff of 3 or more had a sensitivity of 0.854 and a specificity of 0.851 in the testing half of the sample. That sample was limited to white adults of European descent, so accuracy in other groups needs further study.",false,"2005","HiBoop offers the ORT-OUD, the 9-item revised Opioid Risk Tool: send it before opioid therapy starts or continues, and keep the score with the client's record. The original weighted ORT is not offered.",{"heading":346,"scaleLabel":347,"min":348,"max":349,"note":350,"source":351,"bands":352},"ORT-OUD Score Interpreter","ORT-OUD total",0,9,"Revised Opioid Risk Tool (ORT-OUD): 9 yes or no items, 1 point per yes, total 0 to 9. For the original weighted ORT, use the table in the scoring section below.","Cheatle MD et al. J Pain. 2019;20(7):842-851 (cutoff 0-2 vs 3 or more); score labels as printed on the ORT-OUD form distributed by NIDA.",[353,357],{"min":296,"label":354,"level":355,"note":356},"High risk","warning","3 or more indicates high risk for opioid use disorder. A risk flag, not a diagnosis: it informs further assessment, monitoring and the treatment plan.",{"min":348,"label":358,"level":359,"note":360},"Low risk","success","2 or lower indicates low risk for future opioid use disorder. Low risk is not no risk; keep monitoring during opioid therapy.","2026-10-30",{},true,"\u002Fassessments\u002Fopioid-risk-tool","The original ORT is copyrighted by Lynn R. Webster, MD. LOINC carries it with the notice \"© 2018 Dr. Lynn Webster. Used with permission.\", and the AHRQ Academy lists its terms of use as \"Copyrighted, freely available.\" The ORT-OUD was published as an appendix to Cheatle et al. (2019), and the U.S. National Institute on Drug Abuse distributes the form. Check the authors' terms before reproducing either form.",[367,368],"Psychiatric","PrimaryCare",{"title":5,"description":324},"opioid-risk-tool","published","assessments\u002Fopioid-risk-tool","The ORT (Opioid Risk Tool) is a brief risk screen for adults with chronic pain who are on, or being considered for, opioid therapy. The original 2005 ORT is weighted by sex and bands totals as 0 to 3 low, 4 to 7 moderate and 8 or more high risk; the revised 9-item ORT-OUD scores each yes as 1 point, with 0 to 2 low and 3 or more high risk for opioid use disorder.","assessment","I8BZc4e_ApoqO1M1maXF1tFCNiY2Occx6crb_hemelo",[377,382,385,388,392,395],{"slug":378,"title":379,"tier":380,"weight":381},"assist","Alcohol, Smoking and Substance Involvement Screening Test (ASSIST v3.1)","same",100,{"slug":383,"title":384,"tier":380,"weight":381},"arc","Assessment of Recovery Capital (ARC)",{"slug":386,"title":387,"tier":380,"weight":381},"audit","AUDIT Scoring & AUDIT-C · Alcohol Use Disorders Identification Test",{"slug":389,"title":390,"tier":37,"weight":391},"mdq","MDQ: Mood Disorder Questionnaire",45,{"slug":393,"title":394,"tier":37,"weight":391},"ymrs","Young Mania Rating Scale (YMRS): Scoring and Cutoffs",{"slug":396,"title":397,"tier":37,"weight":398},"aces","ACE Score: Scoring & Interpretation of the ACE Questionnaire",40,1794129720122]