The MidMichigan Opioid Risk Assessment (MORA) identifies risk factors for adverse effects associated with opioid therapy.
Medical predictors:
(1) age >= 65 years
(2) dementia
(3) chronic respiratory failure requiring oxygen therapy
(4) sleep apnea
(5) cirrhosis
(6) GFR < 30 mL per min per 1.73 sq m
(7) morphine milligram equivalence (MME) >= 50 mg per day
(8) history of opioid-induced sedation or respiratory depression
(9) concurrent therapy with benzodiazepines
(10) zolpidem or eszopicione (for insomnia)
(11) muscle relaxants
(12) barbiturates
Psychiatric predictors:
(1) major psychiatric disorder
(2) history of suicide attempt
(3) positive GAD-7 screen
(4) positive PHQ-9 screen for depression
(5) positive PC-PTSD-5 screen
(6) history of childhood emotional, physical and/or sexual trauma/abuse
Substance use predictors:
(1) active substance use disorder
(2) history of substance use disorder
(3) medical marijuana use
(4) refusal to abstain from social alcohol use while on opioids
(5) unexpected prescription drug monitoring program (PDMP) report findings
(6) positive urine drug screen with confirmation
(7) violation of the controlled substance agreement
(8) red flags for substance abuse
(9) positive DAST-10 screen
total number of predictors =
= SUM(number of items present)
Interpretation:
• The presence of one or more predictors is associated with high risk for an adverse opioid event.
Requirements for prescribing an opioid for pain:
(1) documentation of medical necessity
(2) risk-benefit assessment with risk mitigation strategy if needed
