The Opioid Risk Tool (Ort) And Work Injury Treatment

In the field of medicine, tools are used to assess treatment’s nature and course.  These tools are used to make assessments to medical treatment. The tools are frequently questionnaires filled out by patients on their own.   These tools are considered a cost-effective and reliable means of obtaining information.

Opioid medications can be prescribed to treat work injuries. They can be used in circumstances of acute injuries and in circumstances of chronic pain. Medical Providers are very concerned over prescribed opioid medications as they are controlled substances and are subject to governmental scrutiny.

This article will discuss the Opioid Risk Tool (ORT), the topics addressed, in the ORT, how the ORT is scored, and why it is the ORT is important.

Are Opioids a Problem Within Workers’ Compensation?

It is reported that the “NCCI data shows that injured workers who were prescribed at least one prescription in 2016 received three times as many opioid prescriptions as the US opioid prescribing rate. These figures illustrate that workers compensation is directly affected by the far-reaching societal impacts of the opioid epidemic in the United States.” ncci

What Is the Opioid Risk Tool (ORT)?

 The ORT was developed by Webster, et al. as a “self-performed screening tool designed for use by adult patients in primary care settings before beginning opioid treatment for pain management.” ncbi

Note: within workers’ compensation medical treatment, there is concern and analysis over what is medically appropriate treatment that is intended to cure or relieve the effects of an injury pursuant to Labor Code Section 4600.   The ORT can be used as a basis for approving or denying the provision of narcotic medications. The ORT information may be employed by Utilization Review and Independent Medical Review for approval or denial of opioid prescriptions.

What are the Topics in the ORT?

The ORT includes the following topics:

  • Patient’s Gender
  • Patient’s Family History of Substance Abuse
    1. Alcohol
    2. Illegal Drugs
    3. Prescription Drugs
  • Patient’s Personal History of Substance Abuse
    1. Alcohol
    2. Illegal Drugs
    3. Prescription Drugs
  • Patient’s Age Range of Patient, Specially between 16 to 45 years
  • Patient’s History of Preadolescent Sexual Abuse
  • Patient’s Psychological Disease
    1. Attention Deficit Hyperactivity Disorder
    2. Obsessive-Compulsive Disorder
    3. Bipolar Disorder
    4. Schizophrenia
    5. Depression

How Is the Questionnaire Scored?

The scoring on the questions are as follow:

“Family history of substance abuse including alcohol (Female=1; Male=3), illegal drugs (2;3), and/or prescription drugs (4;4) Personal history of substance abuse including alcohol (Female=3; Male=3), illegal drugs (4;4), and/or prescription drugs (5;5) Whether the patient age range is between 16 to 45 years (1;1) A history of preadolescent sexual abuse (3;0) Psychological disease including attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), bipolar disorder, schizophrenia (2;2); and/or depression (1;1).ncbi 

Note: There are gender differences when scoring the test.   Some drug and alcohol abuse answers score higher for males, and only females receive a score on the issue of preadolescent sexual abuse.

What Does the Score Mean?

“Scores are summed, and a score of 3 or below suggests a low risk for future opioid abuse, while a score of 4 to 7 indicates moderate risk. A score of 8 or greater suggests a high risk of future abusive drug-related behavior.” ncbi

Note:  Score suggesting a high risk of future abusive drug-related behavior may be used to call into question prescriptions for those patients.

How Does This Impact Injured Workers?

Medical providers will analyze these scores as part of their decision to prescribe opioid medications.  If the scores are too high, it is likely that a provider will consider alternative forms of medication and treatment for the individual to avoid the possibility of substance abuse.

Further, if opioids are prescribed to at risk patients, there may be additional monitoring taking place. “ Higher risk patients require more frequent monitoring than lower-risk patients. Follow-ups may include re-screening of risk, urine drug screening, and observation for other clues of drug abuse. These clues may consist of requests for dose escalation, doctor shopping, forging prescriptions, requesting early prescriptions, unscheduled clinic visits, or emergency room visits with complaints of pain.” ncbi

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for over 28 years. Contact us today for more information.



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