The reason these cuts hadn’t worked, some experts believed, was that they had failed to target the patients at highest risk. Around 70 percent of adults have taken medical opioids—yet only 0.5 percent suffer from what is officially labeled “opioid use disorder,” more commonly called addiction. One study found that even within the age group at highest risk, teenagers and people in their early twenties, only one out of every 314 privately insured patients who had been prescribed opioids developed problems with them.
Researchers had known for years that some patients were at higher risk for addiction than others. Studies have shown, for instance, that the more adverse childhood experiences someone has had—like being abused or neglected or losing a parent—the greater their risk. Another big risk factor is mental illness, which affects at least 64 percent of all people with opioid use disorder. But while experts were aware of these hazards, they had no good way to quantify them.
That began to change as the opioid epidemic escalated and demand grew for a simple tool that could more accurately predict a patient’s risk. One of the first of these measures, the Opioid Risk Tool (ORT), was published in 2005 by Lynn Webster, a former president of the American Academy of Pain Medicine, who now works in the pharmaceutical industry. (Webster has also previously received speaking fees from opioid manufacturers.)
To build the ORT, Webster began by searching for …….