Opioid Risk Assessments.

[101N]

Worthwhile or largely a waste of time? Cite sources to support your position.
And yes, I know that both the OMB & FSMB Guidelines recommend using them.

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[drusso]

We risk stratify everyone as a SOC and I expect to see a statement about risk and informed consent in every chart I review.

 

[lobelsteve]

The tests are useful for documentation, but the patient can easily lie on answers to effect outcomes.

 

[Ducttape]

imo, lying to a physician is an act of deception, for which the patient is responsible.
not documenting risk stratification - of any sort - is an act of omission, for which the physician is responsible.

 

[101N]

So, you ask them: "Do you have a history of drug or alcohol abuse/misuse: Yes/No
I think that's helpful and I do it myself. But where is the evidence that more formal
risk stratification - ORT/DIRE/SOAPP-R/ etc - actually predicts misuse? Where
is the evidence?

I think screening tools for the 'central pain' phenotype hold a lot more promise -
for predicting opioid misuse/abuse -than dose using the traditional risk assessment tools.

Ajay Wasan - & Beverly Thorn, Jennifer Haythornwaite, Roger Filligim, - is all over this.

 

[ampaphb]

http://www.ncbi.nlm.nih.gov/pubmed/21750461

 

[ampaphb]

I think screening tools for the 'central pain' phenotype hold a lot more promise - for predicting opioid misuse/abuse - than dose using the traditional risk assessment tools.

I look forward to seeing studies that validate your thoughts

Sent from my SAMSUNG-SM-G920A using SDN mobile

 

[drusso]

So, you ask them: "Do you have a history of drug or alcohol abuse/misuse: Yes/No
I think that's helpful and I do it myself. But where is the evidence that more formal
risk stratification - ORT/DIRE/SOAPP-R/ etc - actually predicts misuse? Where
is the evidence?

I think screening tools for the 'central pain' phenotype hold a lot more promise - for predicting opioid misuse/abuse -than dose using the traditional risk assessment tools.

We use an MSW/LCSW for the very reason that a human being can ask relevant follow-up questions. Addicts lie, but are relatively easy to "catch" if you know the culture of addiction and what questions to ask and answers to expect. A Vietnam War era patient who denies EVER trying cannabis is probably not being truthful in order to look good. Someone who claims 20 years without a drink, but later says their last DUI was 15 years ago is confused or not being truthful. Someone who claims, "I don't know why my last doctor stopped prescribing to me," but 10 minutes later says, "Sure, I've taken more medication than I was prescribed if my pain is really bad" is similarly confused. Teasing out these inconsistencies makes all the difference for a valid risk stratification. I don't think any paper-and-pencil comes close.