2. Opioid Risk Tool screens for aberrant behaviors in patients on long-term opioids using a five-item yes/no format self-report measure. Scores of 0—3 are considered low risk, 4—7 are considered moderate risk, and 8 and over are considered high risk. It has an excellent ability to differentiate low-risk from high-risk patients in both men and women (Exhibit 10.1).

3. Diagnosis, Intractability, Risk, and Efficacy Score is a clinician-rated scale with questions in four categories: diagnosis, intractability, risk, and efficacy. The categories are further divided into psychological, chemical health, reliability, and social support. A score of 14 and above indicates a patient is a good risk for opioid therapy and those with lower scores are not considered good risks for opioid therapy. 4. Current Opioid Misuse Measure (COMM) is a 17-item self-report measure to identify aberrant drug-related behaviors for patients on long-term opioid therapy. The COMM is a newer tool that can identify emotional/psychiatric issues, evidence of lying, appointment patterns, and medication misuse/noncompliance (Passik, Kirsh, & Casper, 2008). Copies of these tools are available at

There are many other tools that can be used to screen patients for opioid misuse and aberrant behaviors, and evaluate risk with opioid use. The above tools are those that are being used most consistently in the current clinical settings.

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