| Prescription Opiate Risk Tool (PORT) History of marijuana use past year 3 History of cocaine, ecstacy, heroin >1 year ago 6 History of cocaine, ecstacy, heroin <1 year ago 10 History of methamphetamine use past year 12 Alcohol abuse past year 10 History of prescription drug abuse 10 Conviction for DUI or drug possession past 5 years 6 Conviction for sale or distribution of drugs 12 Age 17-28 5 Age 28-50 3 Age >50 2 Hx ADD, OCD, bipolar, schizophrenia 4 Hx depression 2 Male 3 Parental hx alcohol or drug abuse 4 Discharged by physician for prescription abuse 5 20 or higher: These are patients considered to have too high of a risk for treatment in most pain clinics. Unless the pain clinic has a certified addictionologist on staff, it is suggested these patients be referred to a comprehensive university pain clinic, no matter how far away. Typically these patients engage in substance abuse or diversion within the first 2 months of treatment in a typical pain clinic. 15 or higher= Very High Risk of Substance Abuse in the next year. It is suggested these patients have very close follow-up with mandatory psychology program participation, never greater than 1 month intervals on follow up, and no multi-month (eg refills on schedule III meds or 3 month mail in scripts) prescriptions. Urine drug screens should be conducted routinely and pill counts should be conducted randomly by the patient's pharmacist or by the clinic staff. Initial visits should be 1-2 week intervals. Extremely high vigilance is necessary. Tight control on the amount of narcotics prescribed and on the patient use of the narcotic is necessary. Do not escalate dosages of narcotics...these patients are on long term maintenance therapy and should not be permitted any latitude in their use of the narcotics. 10-14= High risk of substance abuse. Precautions should be taken with appropriate intensified monitoring, definitely with random drug screening, and interval of follow-up visits should be no more than one month. High level of suspicion regarding any unusual occurrences surrounding prescription narcotics. 7-10= Moderate risk of substance abuse Cautious implementation of longer follow-up intervals. 6 or less=Low risk of substance abuse Only occasional random drug screens needed. After the first 3 months of monthly follow-up visits, the intervals of follow-up visits may be increased, but never to more than 3 months when long acting opiates or significant quantities of short acting schedule II or III drugs are being prescribed. If there are any aberrations after initiation of therapy, re-assess the potential for substance abuse and decrease the intervals between follow up visits. |