McMaster University

Michael G. DeGroote
National Pain Centre

Scope of Search

Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain

Appendix B-2: Opioid Risk Tool

Opioid Risk Tool

Item Mark each box that applies Item score if female Item score if male
1. Family History of Substance Abuse:
         Alcohol    [   ] 1 3
         Illegal Drugs [   ] 2 3
         Prescription Drugs [   ] 4 4
2.  Personal History of Substance Abuse:
         Alcohol    [   ] 3 3
         Illegal Drugs [   ] 4 4
         Prescription Drugs [   ] 5 5
3.  Age (mark box if 16-45) [   ] 1 1
4.  History of Preadolescent Sexual Abuse [   ] 3 0
5. Psychological Disease
Attention Deficit Disorder, Obsessive-Compulsive Disorder, or Bipolar, Schizophrenia [   ] 2 2
Depression [   ] 1 1
Total ____ ____
Total Score Risk Category:
      Low Risk: 0 to 3  
      Moderate Risk: 4 to 7  
      High Risk: 8 and above

— Attribution: By Lynn R. Webster, MD; Medical Director of Lifetree Medical, Inc., Salt Lake City, UT 84106