We see two important and emerging issues in the field of risk assessment. The first is the issue of reviewing and changing a patient’s risk
as treatment goes on. Risk is not a permanent characteristic of the
patient. Risk varies across time. In addition, probably the best predictor of how a patient will use opioids is his or her actual use of opioids. If a patient is able to use opioids without medication aberrant
behavior for a period of time—3 months, 6 months, 1 year—then it
would seem that a lowering of risk score may be in order. While a
few patients may need ongoing close monitoring to continue to do
well, many are showing by their behavior that they are able to take
opioids and not engage in medication aberrant behavior. If a highrisk patient does well in treatment and shows no medication aberrant
behavior, how long does he or she remain labeled as high risk? We
would advocate for a process in which patients can lower their initial
risk rating with “time for good behavior.” Particularly when patients
are being administered UDTs at a frequent rate, third-party payers
will likely appreciate the chance for higher-risk patients to have their
risk reduced at some point so that the high degree of monitoring can
also be decreased to some degree. How and when risk lowering is
done should be addressed by those in the risk assessment field.
The second and perhaps more important issue is for practitioners to
use risk ratings to drive treatment decisions. Risk assessment is not
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3. Moore TM, Jones T, Browder JH, et al. A comparison of common screening methods
for predicting aberrant drug-related behavior among patients receiving opioids for
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THe RiSK LeVeL OF A PATieNT
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VE
ON THe CHOiCe OF OPiOiDS
PReSCRiBeD AND ON THe
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e
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just a checkbox to show that an evaluation was completed and to pass
third-party inspection. The risk level of a patient should have a direct
bearing on the choice of opioids prescribed and on the frequency of
monitoring. The current thinking in the field holds that higher-risk
patients should have more limited access to short-ac [