The Michigan Modified Opioid Risk Tool: Screening for Dependence in Opioid Naive Patients
Opioid addiction in the United States has skyrocketed over the past decade and a half, and has led to a sharp increase in deaths related to narcotics. One factor that has led to this increase in opioid use and addiction is the amount of narcotic prescriptions that are written and filled following surgical procedures. It’s estimated that over 50million surgical procedures occur each year in the United States, and of those patients nearly 80% are prescribed opiates for post-operative pain control.1,2 One can surmise that the first time millions of individuals are exposed to opioids is a result of prescriptions that they receive in the hospital. Furthermore, studies have shown that up to 6.5%of patients that take opioids for post-operative pain control may continue to use these drugs persistently, opening the gateway to addiction and abuse.1 Until recent recognition of the opioid epidemic, there were few regulations on the amount and frequency of opioid prescriptions, and many providers would routinely prescribe excessive amounts of narcotic for the post-operative period. This in turn led to a staggering number of unused opioid medications, up to70% of what was prescribed.2 Nearly all of those unused medications were found to be simply left inside a non-secure location in patient’s homes, leading to potential abuse. One study which looked at patients who were opioid dependent seeking treatment reported that over 30% of those individuals were first exposed to opioids that were left in the house by their family or friends.3 Opioid risk screening tools were developed for patients who were already chronically taking pain medications, however based on our review a tool has yet to have been developed for opioid naïve patients. As a result of this, we decided to develop the Michigan Modified Opioid Risk Tool (MMORT).The MMORT looks at a variety of psychosocial factors, as well as history of substance use/abuse, and age.We simplified our screening tool which is based off of Webster’s opioid risk tool, which takes into account the factors listed above. We modified their tool to simplify it in hopes to provide a brief screening tool that would have utility in the peri-operative setting. Our tool looks at history of mental illnesses, personal history of alcohol or tobacco abuse, and age. If we can identify patients who are at risk of becoming dependent on opioids following surgery, we can offer pre-operative counseling to these patients to educate them about the risks of opioids. This will help providers formulate an opioid sparing plan for their patients in the post-operative period, thus reducing their risk of dependence and potential addiction. We believe the importance of targeting opioid naïve patients is to limit unnecessary opioid exposure following surgery, which again as mentioned above has been linked to dependence and possible addiction.References:1. Brummett, C. M., Waljee, J. F., Goesling, J., Moser, S., Lin, P., Englesbe, M. J., ... & Nallamothu, B. K.(2017). New persistent opioid use after minor and major surgical procedures in US adults. JAMA surgery, 152(6), e170504-e170504.2. Hill, M. V., McMahon, M. L., Stucke, R. S., & Barth, R. J. (2017). Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Annals of surgery, 265(4), 709-714.3. Canfield, M. C., Keller, C. E., Frydrych, L. M., Ashrafioun, L., Purdy, C. H., & Blondell, R. D. (2010).Prescription opioid use among patients seeking treatment for opioid dependence. Journal of addiction medicine, 4(2), 108.
Kraemer J, Lau S, Yaldou BJ, Soto R. The Michigan modified opioid risk tool: screening for dependence in opioid naive patients. Paper presented at: The Annual Meeting of the American Society of Anesthesiologists; 2021 Oct 8-12; San Diego, CA.