App Profile: DIRE

The DIRE Score is a tool that can be used to aid clinicians in their decision-making process when considering prescribing opioids for chronic non-malignant pain. Using the DIRE Score, the clinician rates seven factors each on a scale of 1, 2 or 3 with 1 being the least favorable or highest risk for prescribing opioids and 3 being the most compelling or lowest risk for prescribing.

The seven DIRE factors are: Diagnosis, Intractability, Risk (there are four risk factors—psychological and chemical health, patient reliability and social support/life roles) and Efficacy. Adding the scores for these seven factors gives a total of 7 – 21. A score of 7-13 was predictive of a low probability of success when prescribing opioids; whereas a score of 14-21 was more likely to be associated with a successful prescribing process and outcome.

The DIRE Score does not take into account medical risk factors for opioid prescribing such as comorbid medical conditions (chronic obstructive lung disease, sleep apnea, concomitant use of benzodiazepines, etc.). The clinician should understand that active use of illicit drugs, drug diversion and other aberrant behaviors is incompatible with ongoing opioid prescribing no matter what the DIRE Score may be.

The DIRE Score is not meant to be a substitute for sound clinical judgment in the context of any individual patient. This App is meant for informational use only, and is not intended to aid in the diagnosis, treatment or prevention of disease. Decisions about prescribing are solely the responsibility of the licensed prescriber.