FAQs for NICA Opioid Risk Assessment (NORA)
What is the NICA OPIOID RISK ASSESSMENT (NORA)?
The NICA OPIOID RISK ASSESSMENT (NORA) protocol combines the NICA PSYCHOBIOSOCIAL RISK ASSESSMENT: DIAGNOSTIC INTERVIEW + The NICA OPIOID USE DISORDERS RISK ASSESSMENT: DSM-5-BASED CRITERIA and is a structured, face-to-face, clinical interview specifically designed to be administered by those duly-licensed healthcare professionals who are legally authorized (with the requisite training, credentialing, experience and clinical judgement), to adequately assess salient psychobiosocial risk factors in a given Patient and to render a DSM-5-based (or subsequent DSM-based) diagnosis of any of the Opioid-Related Disorders.
The NORA concludes with a brief NORA ASSESSOR SUMMARY REPORT which has been, especially, structured to enable the Assessor to rapidly summarize both the NICA PSYCHOBIOSOCIAL RISK ASSESSMENT: DIAGNOSTIC INTERVIEW, as well as, the NICA OPIOID USE DISORDERS RISK ASSESSMENT: DSM-5-BASED CRITERIA sections of the NORA and to provide a cumulative RISK FACTOR SEVERITY QUARTILE rating. The two (2) page NORA Assessor Summary Report may be utilized as an abbreviated health care, stand-alone, record if there is need to protect the "raw data" health information of the patient from requestors of the NORA.
What are its objectives?
Creation of the NORA has been specially designed to accomplish three (3) main objectives:
The NORA will save lives by carefully assessing psychobiosocial risk factors in patients for whom opioids are being considered, used, titrated or withdrawn and in evaluating whether or not an Opioid Use Disorder is diagnostically warranted in accordance with the DSM-5- (or subsequent DSM versions) based criteria for which specific recommendations may be made for appropriate treatment or for the inclusion of other appropriate healthcare services.
The NORA will mitigate liability to prescribers, their agencies and payors by providing a systematic methodology for assessing a wide spectrum of psychobiosocial risk factors associated with opioid therapy in a given patient and also for evaluating whether or not a demonstrable DSM-5- (or subsequent DSM versions) based criteria for a diagnosis of Opioid Use Disorder exists in the patient for which clinically relevant and appropriate treatments and/or other healthcare services may be recommended and/or implemented given available resources.
The NORA will conserve money with respect to aggregate healthcare cost offset, across-the-board (inclusive of the ‘system-at-large’ resources), by systematically focusing upon a multitude of psychobiosocial risk factors and upon the American Psychiatric Association’s DSM-5- (or subsequent DSM versions) based criteria diagnostic criteria to carefully screen new patients for whom opioid therapy is being considered by their prescriber and/or to monitor existing patients for whom opioid have been prescribed, as an intentional precursor to opioid prescription (inclusive of titration, withdrawal, etc.).
What is required of an Assessor to utilize this methodology?
The NICA PSYCHOBIOSOCIAL RISK ASSESSMENT: DIAGNOSTIC INTERVIEW requires a professionally competent, duly-licensed Assessor to administer a face-to-face, clinical interview of the Patient in order to render an informed assessment of salient psychobiosocial risk factors which are observationally and inferentially associated with likely opioid risk.
Most of the structured interview questions require a meaningful, elaborated response from the Patient. In addition, a number of questions are designated as “optional” and represent an important opportunity for the experienced diagnostician to ‘probe-the-depths’ of selected content areas based upon various theoretical models related to the constructs of moral behaviors inclusive of “sin, guilt and psychopathology.”
Consequently, the NICA PSYCHOBIOSOCIAL RISK ASSESSMENT: DIAGNOSTIC INTERVIEW and the NICA OPIOID USE DISORDERS RISK ASSESSMENT: DSM-5-BASED CRITERIA are to be administered together, along with any optional psychometric and/or medical testing instruments, for purposes of both assessing risk and making, at least, one or more treatment recommendations, if clinically indicated, to address or otherwise mitigate risk associated with opioid use.
In the event the prevailing DSM-5 is superseded by a more current DSM version, the guidance to the NORA-diagnostician is to fully administer the NICA PSYCHOBIOSOCIAL RISK ASSESSMENT: DIAGNOSTIC INTERVIEW, as-is, and, thereafter, to utilize the NICA OPIOID USE DISORDERS RISK ASSESSMENT: DSM-5-BASED CRITERIA as an heuristic instrument only, pending updating of this latter section of the NORA protocol, if, and only if, there are any substantive revisions made to the Opioid Use Disorders section of the most current DSM.
The entire NORA protocol, consisting of the NICA PSYCHOBIOSOCIAL RISK ASSESSMENT: DIAGNOSTIC INTERVIEW and NICA OPIOID USE DISORDERS RISK ASSESSMENT: DSM-5-BASED CRITERIA, when comprehensively completed with all due-diligence of an intensive face-to-face clinical interview and additional, albeit, optional psychometric and/or medical testing, and when signed and dated by a duly-licensed healthcare professional, represents the entire report of many salient psychobiosocial factors associated with opioid risk and, therefore, must be communicated, in its entirety, to the referring entity.
Lastly, the NORA, consisting of the NICA PSYCHOBIOSOCIAL RISK ASSESSMENT: DIAGNOSTIC INTERVIEW and NICA OPIOID USE DISORDERS RISK ASSESSMENT: DSM-5-BASED CRITERIA are not, necessarily, the only methodology to meaningfully assess risk of potential or actual opioid use, abuse, dependency, tolerance, withdrawal, or additional healthcare consideration of salient risk factors which may positively or negatively impact consideration of opioid therapy.
Moreover, it is not, necessarily, the case that a Patient who may responsibly ‘depend’ upon prescribed opioids to mitigate their pain is automatically to be viewed for purposes of this NORA assessment as, ipso facto, ‘dependent’ upon opioids due to the multiplicity of factors which contribute to the individualized assessment of a given Patient. Hence, a modicum of clinical judgement is required to render an accurate assessment and resultant clinical diagnosis, if an opioid-related disorder exists in the Patient and if it represents risk to that specific individual
What if I want special training and/or supervision in its administration and interpretation?
Larry B. Gelman, Psy. D. and Glenn B. Gelman, Psy. D. are available, by appointment only, to provide special individualized training and/or supervision to prospective healthcare Assessors in the administration and interpretation of the NORA at their usual and customary fee-for-service (FFS) rates. Discounted rates are available for groups of five (5) or more.
Pre-payment and non-cancellation is required for all scheduled services, herein.
Where can I obtain more information?
For more information about the NORA, call 1-815-455-6736 or click on the links, below:
How can I purchase the NORA?
To purchase the NORA, call us at 1-815-455-6736
-versions of the NORA currently available:
eDigital-version of NORA Protocol
Print Copy of NORA Protocol
What are the NORA user qualifications?
If you are a healthcare practitioner who is duly-licensed (if professional licensure is required) and legally authorized (with the requisite training, credentialing, experience and clinical judgement), to adequately render a DSM-5-based (or subsequent DSM-based) diagnosis of any of the Opioid-Related Disorders, OR if you are a healthcare practitioner who by virtue of comparable and demonstrable experiential “merit and fitness” would, otherwise, qualify for and, therefore, be accorded equivalent professional status by a bona fide licensing body, reputable medical, mental health, alcohol and/or other drug treatment healthcare entity, a governmental agency and/or court system (inclusive of probation services), then by your purchase of any NORA usages, you are, hereby, formally attesting to your having met the requisite user qualifications, per above, and, as such, you agree to assume all responsibility and all accountability for the diligent administration, scoring, interpretation, diagnosis, report summary/writing, accurate communication of obtained results, and all due diligence directly associated with professional discipline specific codes of ethics, applicable laws, and privacy practices. You are, also, apprised that if you believe that you do qualify to use the NORA under the “merit and fitness” standard, it is incumbent upon you to fully substantiate the professional and experiential foundation of your “merit and fitness” should you be required to do so (e.g., if records are subpoenaed or if you are called upon to provide testimony either as a treating clinician or as a “expert witness”).
CAVEAT: If you are not a healthcare practitioner who qualifies as a NORA user (i.e., Assessor), per above, OR if you are a patient or prospective patient who either would like to be evaluated for a comprehensive psychobiosocial risk assessment for opioid prescription, titration or withdrawal and/or for a DSM-5-based (or subsequent DSM) Opioid-Related Disorders diagnosis along with consideration of possible risk-mitigation services, OR if you are a patient for whom opioid prescription is currently being evaluated or, otherwise, being considered or questioned, you may be able to purchase a copy of the NORA directly and physically bring the blank NORA protocol to a qualified user for a face-to-face interview with signed attestation(s) as to the veracity of the assessment. However, please be advised that you make said purchase at your own risk as there is no guarantee that you will, necessarily, find a qualified user who will agree to provide the due-diligence required for a comprehensive psychobiosocial risk assessment, the DSM-5-based opioid use disorder(s) diagnostic interview and the Summary Report, inclusive, of possible risk-mitigation services.
Lastly, since the NORAis legally protected copyrighted material of the authors intellectual property, all users and purchasers agree, without any reservation, whatsoever, not to duplicate, copy, xerox, screen-shot or, otherwise, make a facsimile as all such copies will be considered as an “UNAUTHORIZED COPY” and, will therefore, be invalid and a prosecutable violation of U.S Copyright law.