Assessing Patients' Risk for Opioid Use Disorder.
Barbara St Marie
PMID 31951657WHAT IT FOUND
Nurses can assess opioid risk using tools like the ORT-OUD and monitor patients via PDMPs and urine screens.
These strategies help identify misuse early, but the tools vary in accuracy and require careful interpretation to avoid stigma.
Key findings
01The Opioid Risk Tool for Opioid Use Disorder (ORT-OUD) demonstrated high sensitivity and specificity in predicting the development of OUD in patients with chronic pain on long-term opioid therapy.
02Urine drug toxicology screening is standard care for managing chronic pain but can lead to misinterpretation and stigma if not used with confirmatory tests like GCMS.
03Nurses can gain access to Prescription Drug Monitoring Programs (PDMPs) in some states to help identify patterns of potential misuse and dangerous medication combinations.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a narrative review, not a systematic review or meta-analysis, so it may not capture all relevant evidence or provide pooled effect sizes. The paper notes that evidence for the diagnostic accuracy of many opioid risk tools is insufficient or low. State laws regarding nurse access to PDMPs vary significantly, limiting the generalizability of this recommendation. The review relies on studies with varying designs and populations, which may affect the applicability of specific tool cutoffs to all patient groups.
The easy way to misread this
Do not treat the reported sensitivity and specificity of tools like ORT-OUD as definitive proof of efficacy for all patients. The paper states that evidence for many risk tools is low and that cutoff scores can be arbitrary. Also, do not assume a negative urine drug test means a patient is not using opioids, as immunoassays often miss synthetic opioids like methadone.