ORT-OUD is a 9-item, unweighted revision of the original Opioid Risk Tool that removes the preadolescent sexual abuse item and sex-based weighting, focusing on family and personal substance use history, age 16–45 years and selected psychiatric illness.

Cheatle et al. derived and evaluated ORT-OUD using baseline data from 1,178 adults (≥18 years) with chronic non-malignant musculoskeletal or neuropathic pain (CNMP) on long-term opioid therapy, recruited from pain, primary care and addiction services in several US regions. Controls (n=781) had no evidence of opioid use disorder (OUD). Cases (n=397) developed OUD after commencing long-term opioids.

Study	Population	Outcome	Key findings
Cheatle et al., 2019	Adults of European descent with CNMP on ≥6 months of long-term opioid therapy (n=1,178)	OUD status after starting long-term opioids	Unweighted 9-item ORT-OUD (score 0–9) with cut-off ≥3 showed sensitivity and specificity both around 0.85, positive predictive value around 0.76 and negative predictive value around 0.91 for OUD.
Chamoun et al., 2023	Arabic translation tested in Lebanese general-population sample (n=581) and OUD clinical sample (n=46)	OUD risk and convergence with ASSIST subscales	Four-factor structure, moderate internal consistency (Cronbach’s alpha ~0.65), good test–retest reliability and positive correlations with ASSIST opioid, sedative and alcohol scores, using the same 0–2 vs ≥3 cut-off.

In the parent CNMP study, eligibility was restricted to patients of European descent with musculoskeletal or neuropathic pain persisting ≥6 months and on long-term opioid therapy. cancer-related pain, other pain syndromes, non-European ancestry and severe psychiatric illness preventing assessment were excluded. Performance in other populations, including Aboriginal and Torres Strait Islander peoples and patients with cancer-related pain, is uncertain.

ORT-OUD is intended as a brief screen for future OUD risk when initiating or continuing long-term opioid therapy. Interpret scores alongside a detailed pain and substance-use history, mental health assessment, prescription monitoring data and, where appropriate, urine drug testing.

Use the result to plan risk mitigation, monitoring intensity and supportive prescribing conversations. It should not be used to deny appropriate analgesia or to make opioid-treatment decisions without shared decision-making, clinical assessment, prescription-monitoring review and local controlled-medicine policy.

Use of Revised Opioid Risk Tool (ORT-OUD) for opioid use disorder risk screening