Commentary: Risk Assessment in the Digital Age
I congratulate the authors of this article on a new screening tool for their research and lucid writing.1 It is clear today that risk assessment and stratification are essential to mitigating risk with opioid use, and improvements in this area are necessary and timely.
An interesting result from the study found aberrant, drug-related behavior in less than 30% of the group at high risk. This means that greater than 70% of high-risk patients did not demonstrate aberrant drug-related behavior within the time period monitored, though lifetime prevalence is probably different.
Tools to assess the potential for risk with opioids can be clinically useful. However, I would caution all clinicians not to rely exclusively on any assessment tool as their only method to assess risk. Risk assessment is not “one and done.” The monitoring of patient response to opioid therapy must be ongoing, and aberrant behaviors may emerge due to dynamic environmental changes in a patient’s life, causing a patient who displayed few signs of vulnerability to harm with opioids at the onset of treatment to become vulnerable.
The tool presented by Gostine and colleagues provides the medical community with a user-friendly electronic means to assess risk. Pain practitioners will welcome this advance, and should be encouraged to always assess risk and monitor accordingly, regardless of the clinical tool they choose.