There was a time when opioids were used exclusively to help manage the pain of cancer, palliative care and end- of-life patients, not the litany of ailments they are often prescribed for today. For C-sections, chronic pain, fractures, contusions, dental surgery, foot surgery and more, physicians typically used non-opioid alternatives to treat their patients.
In the late 1990s, the world changed dramatically as pain was
officially recognized as the fifth vital sign. Many physicians became more comfortable prescribing opioids to a plethora of patients, and medical students and physicians were told that opioids were not addictive (i.e., the benefits outweighed the risk of
addiction in chronic pain), largely driven by a surge in opioid
marketing campaigns. By 2012, healthcare providers wrote 259
million prescriptions for opioid pain medication, enough for
every adult in the United States to have a bottle of pills.
With over 52,000 Americans dying from drug overdoses in
2015, and approximately 63% of those deaths involving the use
of opioids, the consequences of these practices have become
much more real. It is important to take a harder look at non-opioid alternatives that could be used to help to reduce the chance
that patients will become dependent or addicted to opioids.
Survey-based screening tools
Screening tools for opioids have been around for decades. One of
the most common tools in use is called the Screener and Opioid
Assessment for Patients with Pain-Revised (SOAPP-R). SOAP-R
is a tool for clinicians to help determine how much monitoring a
patient on long-term opioid therapy might require.
The survey questions can be filled out in less than 10 min-
utes by answering 24 questions such as: How often do you have
mood swings? How often do you feel bored? How often have
you felt a craving for medication? The tool is administered by
clinicians to patients at their initial visit and various studies
have shown the tool to be effective in carefully predicting sub-
Another tool, the Opioid Risk Tool (OPT) invented by Lynn
Webster, M.D., can be completed by a patient in less than five
minutes. The OPT scores patients based on their gender and
a series of five questions focused on whether the patient and
the patient’s family has a history of substance abuse, age being
from 16-45, a history of preadolescent sexual abuse, and the
existence of psychological diseases (e.g., attention deficit disorder, obsessive compulsive disorder, bipolar, schizophrenia and
depression). The tool has been effective in pilot studies of correctly predicting which patients were at the highest and lowest
risk of exhibiting aberrant, drug-related behaviors associated
with abuse or addiction.
These tools, as well as the new opioid prescribing guidelines
shared by the CDC and various states, offer good alternatives
to prescribing opioids.
Predictive models of tomorrow
It is not news that the use of advanced analytics has been on
the rise across many industries, especially in the insurance industry. A number of companies are using predictive models
and behavioral health screens to assess an individual’s risk for
dependency, and steering some injured workers to non-opioid
A Deloitte Consulting LLP article focused on reversing the
opioid epidemic. Opioid predictive models were described which
AVOIDING DEPENDENCY & ADDICTION
Pedro Arboleda, Kevin Bingham, Randy Gordon,
and Alanna Hughes