NORTHERN ILLINOIS COUNSELING ASSOCIATES, P.C. (NICA)
NICA OPIOID RISK ASSESSMENT (NORA)
PSYCHOBIOSOCIAL RISK CONSIDERATIONS
THE OPIOID EPIDEMIC
According to the National Institute on Drug Abuse (NIDA) (Revised January 2019), every day, more than 130 people in the United States die after overdosing on opioids. The misuse of, and addiction to, opioids — including prescription pain relievers, heroin, and synthetic opioids such as fentanyl — are a serious national crisis that affects public health as well as social and economic welfare.
The Centers for Disease Control and Prevention (CDC) estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.
Further information may be found at:
National Institute of Drug Abuse (NIDA) Opioid Overdose Crisis website at:
According to the CDC Guideline for Prescribing Opioids for Chronic Pain-United States, 2016, opioids are commonly prescribed for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.
Medical prescribers of opioid pain medications are strongly encouraged to be thoroughly familiar with these federal guidelines, including applicable state, local or other relevant community standards.
Further information may be found at:
Centers for Disease Control and Prevention (CDC) website at:https://www.cdc.gov/
Further information may be found at:
Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain — United States, 2016 website at:
THE NICA OPIOID RISK ASSESSMENT
The NICA OPIOID RISK ASSESSMENT (NORA) protocol combines the NICA PSYCHOBIOSOCIAL RISK ASSESSMENT: DIAGNOSTIC INTERVIEW and 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 render a DSM-5-based (or subsequent DSM-based) diagnosis of any of the Opioid-Related Disorders.
The protocol is to be administered in its entirety and, when completed, represents a significant psychobiosocial foundation upon which an assessment of risk and an assessment of DSM-5-based (or subsequent DSM-based) opioid-related diagnosis may be made.
Additionally, the entire protocol is the report, in toto, of the NICA OPIOID RISK ASSESSMENT (NORA) and serves as an organic document to facilitate meaningful clinical inquiry and continuing dialogue with the Patient about the multiple life-domain stressors associated with their potential or actual opioid use, abuse, dependency, tolerance, withdrawal, and/or additional healthcare consideration of salient risk factors which may positively or negatively impact consideration of opioid therapy.
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.
Further information may be found at:
Northern Illinois Counseling Associates, P.C. website at: http://www.nicapc.com/
PROVIDER CAUTIONARY NOTE
The information presented, herein, is based upon the NICA PSYCHOBIOSOCIAL RISK ASSESSMENT: DIAGNOSTIC INTERVIEW and NICA OPIOID USE DISORDERS RISK ASSESSMENT: DSM-5-BASED CRITERIA (hereafter referred to as the NORA protocol), Patient’s expressed and implied attestations that all representations, all clinical interview information provided, and all testing item-endorsements, if applicable, are entirely accurate and true.
Consequently, the extant data utilized in formulating the entire NORA protocol (inclusive of any formal psychological and/or other medical testing results) might be adversely affected by specific and/or other relevant information requested by the Assessor but not, entirely, offered or provided by the Patient.
Furthermore, the present findings may require additional re-evaluation and/or reconsideration if it is determined that the information provided by and/or otherwise obtained from the Patient is later deemed, proved, or otherwise demonstrated to be invalid, erroneous, incorrect, misleading, deceptive, incomplete, distorted, or untrue.
PROVISIONAL CONSULTATIVE GUIDANCE
The following OPIOID RISK ASSESSMENT PROVISIONAL CONSULTATIVE GUIDANCE, along with any psychological and/or medical test-results regarding the NORA Patient identified in the accompanying materials, and the resultant healthcare-Assessor’s considered professional opinion(s) expressed, viz., to:
RECOMMEND, RECOMMEND WITH CAUTION or CANNOT RECOMMEND
are based upon clinical consideration of exclusionary and/or cautionary psychobiosocial risk factors, endemic to the NORA Protocol, which must not be used as the sole source or as the sole determining consideration regarding the Patient’s medical suitability for opioid therapy or as the sole source or as the sole determining consideration for medically denying opioid therapy, especially, since it is the authors’ professional opinion that medical decisions about, primarily, medical procedures, are the appropriate purview of medical practitioners.
Consequently, the following NORA protocol clinical interview data and summary diagnostic impressions regarding the identified Patient, as identified in the accompanying materials, are intended to provide meaningful, useful and relevant supportive evaluative information, as one part of a multi-disciplinary assessment presaging medical determination of the appropriateness of an opioid trial, prescription, therapy, or titration, for the identified Patient in question.
The NICA Opioid Risk Assessment (NORA) requires appropriate professional education, training, licensure (or other certification), experience and good clinical judgement to responsibly administer its face-to-face structured Diagnostic Interview, as well as, to render a reliable and valid evaluation of a given patient in accordance with APA’s prevailing DSM-Based Diagnostic Criteria.
It has been specially designed to be an ‘organic’ interactive assessment instrument to carefully examine, a priori, many psychobiosocial risk factors in a patient’s life, some or all of which may have clinical implications, with impact and consequence, upon their consideration of opioid (or other narcotic) prescription, medication adjustment, titration or withdrawal. Since no assessment instrument is presumed to be “all-inclusive”, the end-user is free to identify other relevant risk factors, not included in the NORA, and incorporate them into the Assessor Summary Report at the end of the NORA.
The NICA Opioid Risk Assessment (NORA) is offered and sold, “as-is”, without any expressed or implied warranties or guarantees, whatsoever. As such, the authors, publishers and purveyors of the NORA disclaim any responsibility for all liability, errors or omissions, personal or professional harm or injury, property loss or damage, however alleged, attributed or caused, relating to any information or use, of the NORA, without any and/or all exception.
Since clinical interview, screening, assessment, evaluation, diagnosis, recommendations for further disposition and mental or medical health ‘practices’ are an inexact science, no assurances can be made regarding any clinical interview, screening, assessment, evaluation, diagnosis, recommendations for further disposition and mental or medical health ‘practices’ (which may include therapeutic outcomes). Consequently, no assurances are made and all users of the NORA, and/or all of their responsible parties, will hold harmless, Northern Illinois Counseling Associates, P.C. (NICA) [including its officers, directors, employees, independent contractors, agents, assigns, designees, and/or interns] in perpetuity, from any and all claims resulting from any and/or all services rendered.
Administering the NICA PSYCHOBIOSOCIAL RISK ASSESSMENT: DIAGNOSTIC INTERVIEW
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.