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In the past, assessment of risk for opioids was overlooked, and the result is a widespread epidemic of prescription opioid abuse, overdose deaths, and the related transition to heroin abuse and crime. Validated evidence-based tools must be used to assess high-risk medications before prescribing and should be incorporated into routine care and into the healthcare structure. Included in the risk assessment should be the Opioid Risk Tool score, a pain history, an opioid history, a psychiatry history, a urine toxicology screen, calculation of the oral morphine equivalent dose, and a check of the Prescription Monitoring Program. Providers sometimes feel discomfort addressing the sensitive questions about psychiatry history, especially about preadolescent sexual experience, but this discomfort is unfounded and based on gender-specific biases of the provider that must be addressed if any resolution to the opioid crisis in the United States is to be attained. The Opioid Risk Tool is a validated 5-item questionnaire that predicts future aberrant behaviors consistent with opioid dependency and addiction. It can be incorporated into system structures as a stop/pause/think method, to encourage taking risk assessments and to help guide prescribing. This article outlines the argument that systems should incorporate validated evidence based tools into their Electronic Medical Record to address pathology that is present in the community. It outlines for clinicians the issues involved with obtaining opioid risk, including relevant gender biases and offers strategies and scripts to communicate with patients more effectively.

DOI: 10.1007/978-3-319-64774-6_15

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