VA’s RIOSORD risk index falls short in many ways

The RIOSORD was designed by the VA to assess the Risk Index for Overdose or Serious Opioid-Induced Respiratory Depression, or basically that your pain medications could stop your breathing. It awarded points for many different conditions, some high, some low. It failed to distinguish between opioid dependence (what regular chronic pain patients have when using opioids long-term) and opioid use disorder (which is what addicts have). There is a big difference between the two and to some providers they don’t understand or care to know the difference. The index fails to address any of the sleeping pills (Z-drugs) or OTC meds like Benadryl that patients use to help their sleep. But one of the biggest flaws I see is that the VA was ignoring the “elephant in the room.” Most veterans are men, and most of these men drink alcohol. Alcohol suppresses the respiratory drive and when mixed with opioids, it increases the likelihood of an event. But guess what? The index FAILS to ask any questions regarding alcohol use!