Are You Effectively Assessing Risk When Prescribing Opioids?

By: John Cole

Reading Time: 6 minutes

The staggering rate of prescription opioid misuse, abuse, and overdose has placed a heavy burden on prescribing clinicians and their practices. Federal and state regulators have responded by enacting extensive opioid prescribing guidelines. Across the board, these guidelines prioritize the importance of properly assessing a patient’s risk of misuse or abuse.

Risk Assessment Meter

When developing and implementing prescribing protocols across a healthcare organization, it is essential to make protocols risk-informed using evidence-based assessment tools. These tools assess a patient’s risk of misuse or abuse, but effective protocols also include mental health screenings to evaluate mood and anxiety disorders. Dr. Martin D. Cheattle effectively  highlights safe opioid prescribing tools for risk assessment in a recent article.

The different instruments/assessments used for determining a patient’s risk vary by the patient’s stage and include:

  • Risk assessments prior to initiating long term opioid therapy
  • Risk monitoring assessments for patients currently undergoing long-term or chronic opioid therapy (consistent use for more than 90 days)
  • Screening tools for non-opioid general substance abuse

Below is a breakdown of the different tools used to identify and quantify patient risk: 

Examples of Instruments Assessing Opioid and Non Opioid Risk


Risk Assessments Prior to Initiating Long-Term Opioid Therapy

Risk Monitoring Assessments in Patient’s Receiving Long-Term Opioid Therapy

Screening Tools for Non-Opioid Substance Abuse

When determining whether a patient is fit for long-term opioid therapy or to continue opioid therapy, it is important to screen for illicit or non-prescribed drug use, alcohol use, and tobacco use. The combination of these with prescribed opioids could have adverse consequences. There are a number of tools used to detect drug and alcohol abuse (see table above).

Evaluating A Patient’s Mental Health

As the Journal of Clinical Psychiatry reports that one in three adults who struggle with alcohol or drug abuse also suffers from depression, it is important to screen a patient for mood and anxiety disorders. If a disorder is undetected and/or not treated, it can lead to opioid misuse or abuse. Some commonly used tools include:

SAMSHA's Center for Integrated Health Solutions provides additional resources related to screening tools focusing on mental health and substance abuse. 

Assessing the 4 A's

In addition to screening patients, it is important for providers to include the "4 A's" in assessments:

  • Analgesia (pain relief)
  • Activities of Daily Living (psychosocial functioning)
  • Adverse Effects (side effects)
  • Aberrant Drug Taking (addiction related outcomes)

Taking Action at Your Practice

Patient risk identification and assessment is a critical aspect of developing effective opioid prescribing protocols. Here are a few general tips to get started:

  • Review all applicable guidelines and regulations
  • Select the risk assessment tools appropriate for your practice by collaborating with clinicians
  • Run a pilot and collect feedback/suggestions from participating clinicians


For more, check out our recent posts on related topics:

At AffirmHealth, we understand that developing prescribing protocols takes considerable time and effort. We partner with organizations to build and implement risk-informed protocols tailored to the practice. Our new product Shield is a software platform to help manage, facilitate and measure prescribing compliance using those protocols. We would welcome the opportunity to partner with your organization.

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