Risk Tool Helps Pharmacists Qualify Patients for Take-Home Naloxone

DECEMBER 18, 2015
Who Should Receive Take-Home Naloxone?
The American Medical Association released a statement in July 2015 advocating for dual prescribing of naloxone and opioids to patients at risk for drug overdose.6 This, of course, begged the question: who are those at risk? 
Some believe every patient receiving chronic opioid therapy is at risk. Until recently, there has not been a validated risk assessment tool to ascertain otherwise.
There is the Atherosclerotic Cardiovascular Disease (ASCVD) score to guide statin therapy,7 the Fracture Risk Assessment (FRAX) tool to guide osteoporosis therapy,8 and the CHADS2-VASc score to guide anticoagulant therapy,9 but heretofore, there has been no numerical risk scoring system to guide naloxone prescribing. 
The Risk Index for Overdose or Serious Opioid-Induced Respiratory Depression (RIOSORD)
The authors behind the RIOSORD score first validated this risk index in US veterans.10 Readers can access an automated 15-question Excel sheet scoring tool based on this original validation here.

Subsequently, the same authors validated RIOSORD in the general population, which was presented in poster form and is provided here with their permission.11 This was a case-control analysis in a cohort of 18 million patients using prescription claims data.
The authors identified 7234 cases of overdose or serious opioid-induced respiratory depression (OSORD) and compared them with 28,932 controls. Common risk factors associated with OSORD were assigned a score for each risk factor using multivariable logistic regression modeling.
This newer RIOSORD tool for the general population is a 16-question survey, which is available here in an automated Excel file for ease of use by pharmacists. It has a total maximum score of 146 points.
The calculated total RIOSORD score corresponds to an average predicted probability of OSORD of 2% to 84%.

Jeffrey Fudin, PharmD, DAIPM, FCCP, FASHP
Jeffrey Fudin, PharmD, DAIPM, FCCP, FASHP
Dr. Jeff Fudin graduated from Albany College of Pharmacy & Health Sciences with a BS and PharmD. He is a Diplomate to the Academy of Integrative Pain Management, a Fellow to ACCP, ASHP, & FSMB, a member of several other professional organizations. He is CEO of Remitigate (remitigate.com), an opioid safety software development LLC. Dr. Fudin is a section editor for Pain Medicine & Co_Editor-A-Large for Practical Pain Management. He practices as a clinical pharmacy specialist (WOC) and director of PGY-2 pharmacy pain residency programs at the Stratton Veterans Administration Medical Center in Albany, New York and has academic affiliations with Western New England University and Albany Colleges of Pharmacy.