Select practice behaviors of clinicians on the use of opioids for adolescents with subacute and chronic nonmalignant pain

2018 ◽  
Vol 7 (2) ◽  
pp. 123-134 ◽  
Author(s):  
John M. Saroyan, MD ◽  
Wendy Y. Cheng, MPH ◽  
Damani C. Taylor, BA ◽  
Amna Afzal, MD ◽  
Nomita Sonty, MPhil, PhD ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Reference Group ◽  
Self Report ◽  
Prescribing Practices ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Practice Behaviors ◽  
Scoliosis Correction ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

Objectives: To characterize the opioid prescribing and monitoring practices of providers for chronic nonmalignant pain (CNP) and subacute postoperative pain (SAPOP) in adolescents.Design: Web-based cross-sectional self-report survey.Setting: Free-standing pediatric tertiary academic center.Participants: A total of 183 physicians and nurse practitioners were eligible. Of 115 (62.8 percent) participants who responded, 108 (93.9 percent) completed the survey.Main outcome measures: Self-reported frequency of opioid prescription for SAPOP and CNP conditions and frequency of associated monitoring practices.Results: For 10 of the 13 pain conditions included, some participants endorsed “monthly or more opioid prescriptions” while others endorsed “opioids do not represent appropriate management.” Opioid prescribing is present for almost all pain conditions but is substantially more common for nonacute vaso-occlusive-related sickle cell disease, scoliosis correction, and video-assisted pectus excavatumrelated pains. When compared with the reference group, CNP with no identifiable pathology, the odds ratio (OR) of an opioid being prescribed for CNP states with identifiable pathology was not significantly higher. The OR for SAPOP was significantly higher (p 0.0001). None of the opioid prescribers reported collecting urine toxicology before or during opioid therapy.Conclusions: This survey identifies a diversity of self-reported clinician opioid prescribing practices for adolescents with CNP and SAPOP. Urine collection for drug toxicology screening is not utilized by opioid prescribers. Surveys of similar clinician practice behaviors at other institutions are warranted to replicate this finding and to establish common clinical practice for usage and monitoring of opioids in conditions where guidelines do not yet exist.

Academic family medicine physicians' confidence and comfort with opioid analgesic prescribing for patients with chronic nonmalignant pain

2014 ◽  
Vol 10 (4) ◽  
pp. 255 ◽  
Author(s):  
Allison A. Macerollo, MD ◽  
Donald O. Mack, MD ◽  
Rupal Oza, MD, MPH ◽  
Ian M. Bennett, MD, PhD ◽  
Lorraine S. Wallace, PhD
Keyword(s):  
Pain Management ◽  
Family Medicine ◽  
Family Physicians ◽  
Opioid Analgesics ◽  
Comfort Level ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain ◽  
Level Of Concern

Objective: To examine academic family medicine physicians' current practices, experiences, beliefs, level of concern about negative outcomes, and confidence and comfort when prescribing opioid analgesics for chronic nonmalignant pain management. Design: Electronic cross-sectional survey.Participants: This study was part of the Council of Academic Family Medicine (CAFM) Educational Research Alliance omnibus survey of active academic US family physicians.Main outcome measures: Respondents completed survey items addressing their 1) sociodemographic and practice characteristics, 2) current opioid prescribing practices, 3) experiences and beliefs toward prescribing opioid analgesics for chronic nonmalignant pain management, 4) level of concern about negative opioid-related outcomes, and 5) confidence and comfort when prescribing opioid analgesics.Results: The majority of the sample (n = 491) were male (57.8 percent) with 84.1 percent identifying themselves as non-Hispanic white. Nearly all respondents (91.0 percent) reported currently prescribing opioids to patients with chronic nonmalignant pain. Most respondents reported being confident (88.4 percent) and comfortable (76.2 percent) in their prescribing for patients with chronic nonmalignant pain. Family physicians who were comfortable in their opioid prescribing skills were more likely to report satisfaction in prescribing opioids to patients with chronic pain (ρ = 0.494, p < 0.001), while those who were confident in their opioid prescribing skills were more likely to identify pain management as high priority (ρ = -0.287, p < 0.001).Conclusions: Most academic family physicians currently prescribed opioid analgesics to patients with chronic nonmalignant pain. There was a strong inverse relationship between confidence regarding opioid prescription and concern about negative consequences. Similarly, comfort level was tied to increased satisfaction with the overall process of opioid prescription.

The Effects of the Opioid Epidemic on Prescribing Practices in Long-Term Care Residents

2019 ◽  
Vol 34 (4) ◽  
pp. 258-267
Author(s):  
Lisa Yamagishi ◽  
Olivia Erickson ◽  
Kelly Mazzei ◽  
Christine O'Neil ◽  
Khalid M. Kamal
Keyword(s):  
Severe Pain ◽  
Long Term Care ◽  
Care Facility ◽  
The United States ◽  
Self Report ◽  
Prescribing Practices ◽  
Term Care ◽  
Data Set ◽  
Opioid Prescribing

OBJECTIVE: Evaluate opioid prescribing practices for older adults since the opioid crisis in the United States.<br/> DESIGN: Interrupted time-series analysis on retrospective observational cohort study.<br/> SETTING: 176-bed skilled-nursing facility (SNF).<br/> PARTICIPANTS: Patients admitted to a long-term care facility with pain-related diagnoses between October 1, 2015, and March 31, 2017, were included. Residents discharged prior to 14 days were excluded. Of 392 residents, 258 met inclusion criteria with 313 admissions.<br/> MAIN OUTCOME MEASURE: Changes in opioid prescribing frequency between two periods: Q1 to Q3 (Spring 2016) and Q4 to Q6 for pre- and postgovernment countermeasure, respectively.<br/> RESULTS: Opioid prescriptions for patients with pain-related diagnoses decreased during period one at -0.10% per quarter (95% confidence interval [CI] -0.85-0.85; P = 0.99), with the rate of decline increasing at -3.8% per quarter from period 1 and 2 (95% CI -0.23-0.15; P = 0.64). Opioid prescribing from top International Classification of Diseases, Ninth Revision category, "Injury and Poisoning" decreased in prescribing frequency by -3.0% per quarter from Q1 to Q6 (95% CI -0.16-0.10; P = 0.54). Appropriateness of pain-control was obtained from the Minimum Data Set version 3.0 "Percent of Residents Who Self-Report Moderate to Severe Pain (Short Stay)" measure; these results showed a significant increase in inadequacy of pain relief by 0.28% per quarter (95% CI 0.12-0.44; P = 0.009).<br/> CONCLUSION: Residents who self-report moderate- to severe pain have significantly increased since October 2015. Opioid prescriptions may have decreased for elderly patients in SNFs since Spring 2016. Further investigation with a larger population and wider time frame is warranted to further evaluate significance.

Current Opioid Prescribing Patterns after Microdirect Laryngoscopy

2019 ◽  
Vol 129 (2) ◽  
pp. 142-148 ◽  
Author(s):  
Molly N. Huston ◽  
Rouya Kamizi ◽  
Tanya K. Meyer ◽  
Albert L. Merati ◽  
John Paul Giliberto
Keyword(s):  
The United States ◽  
Opioid Abuse ◽  
Prescribing Patterns ◽  
Opioid Analgesia ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
Opioid Prescribing

Background: The prevalence of opioid abuse has become epidemic in the United States. Microdirect laryngoscopy (MDL) is a common otolaryngological procedure, yet prescribing practices for opioids following this operation are not well characterized. Objective: To characterize current opioid-prescribing patterns among otolaryngologists performing MDL. Methods: A cross-sectional survey of otolaryngologists at a national laryngology meeting. Results: Fifty-eight of 205 physician registrants (response rate 28%) completed the survey. Fifty-nine percent of respondents were fellowship-trained in laryngology. Respondents performed an average of 13.3 MDLs per month. Thirty-four percent of surgeons prescribe opioids for over two-thirds of their MDLs, while only 7% of surgeons never prescribe opioids. Eighty-eight percent of surgeons prescribed a combination opioid and acetaminophen compound, hydrocodone being the most common opioid component. Many surgeons prescribe non-opioid analgesics as well, with 70% and 84% of surgeons recommending acetaminophen and ibuprofen after MDL respectively. When opioids were prescribed, patient preference, difficult exposure and history of opioid use were the most influential patient factors. Concerns of opioid abuse, the physician role in the opioid crisis, and literature about postoperative non-opioid analgesia were also underlying themes in influencing opioid prescription patterns after MDL. Conclusions: In this study, over 90% of practicing physicians surveyed are prescribing opioids after MDL, though many are also prescribing non-opioid analgesia as well. Further studies should be completed to investigate the needs of patients following MDL in order to allow physicians to selectively and appropriately prescribe opioid analgesia postoperatively.

scholarly journals Opioid analgesic use after ambulatory surgery: a descriptive prospective cohort study of factors associated with quantities prescribed and consumed

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e047928
Author(s):  
Christopher W Shanahan ◽  
Olivia Reding ◽  
Inga Holmdahl ◽  
Julia Keosaian ◽  
Ziming Xuan ◽  
...  
Keyword(s):  
Chronic Pain ◽  
High Risk ◽  
Drug Use ◽  
Opioid Analgesic ◽  
Safety Net ◽  
Opioid Consumption ◽  
Secondary Outcome ◽  
Prescribing Practices ◽  
Opioid Prescription ◽  
Opioid Prescribing

ObjectivesTo prospectively characterise: (1) postoperative opioid analgesic prescribing practices; (2) experience of patients undergoing elective ambulatory surgeries and (3) impact of patient risk for medication misuse on postoperative pain management.DesignLongitudinal survey of patients 7 days before and 7–14 days after surgery.SettingAcademic urban safety-net hospital.Participants181 participants recruited, 18 surgeons, follow-up data from 149 participants (82% retention); 54% women; mean age: 49 years.InterventionsNone.Primary and secondary outcome measuresTotal morphine equivalent dose (MED) prescribed and consumed, percentage of unused opioids.ResultsSurgeons postoperatively prescribed a mean of 242 total MED per patient, equivalent to 32 oxycodone (5 mg) pills. Participants used a mean of 116 MEDs (48%), equivalent to 18 oxycodone (5 mg) pills (~145 mg of oxycodone remaining per patient). A 10-year increase in patient age was associated with 12 (95% CI (−2.05 to –0.35)) total MED fewer prescribed opioids. Each one-point increase in the preoperative Graded Chronic Pain Scale was associated with an 18 (6.84 to 29.60) total MED increase in opioid consumption, and 5% (−0.09% to –0.005%) fewer unused opioids. Prior opioid prescription was associated with a 55 (5.38 to –104.82) total MED increase in opioid consumption, and 19% (−0.35% to –0.02%) fewer unused opioids. High-risk drug use was associated with 9% (−0.19% to 0.002%) fewer unused opioids. Pain severity in previous 3 months, high-risk alcohol, use and prior opioid prescription were not associated with postoperative prescribing practices.ConclusionsParticipants with a preoperative history of chronic pain, prior opioid prescription, and high-risk drug use were more likely to consume higher amounts of opioid medications postoperatively. Additionally, surgeons did not incorporate key patient-level factors (eg, substance use, preoperative pain) into opioid prescribing practices. Opportunities to improve postoperative opioid prescribing include system changes among surgical specialties, and patient education and monitoring.

scholarly journals Trends in opioid prescribing practices in South Korea, 2009–2019: Are we safe from an opioid epidemic?

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250972
Author(s):  
Noo Ree Cho ◽  
Young Jin Chang ◽  
Dongchul Lee ◽  
Ji Ro Kim ◽  
Dai Sik Ko ◽  
...  
Keyword(s):  
South Korea ◽  
Extended Release ◽  
Population Based ◽  
Prescription Opioid ◽  
Prescribing Practices ◽  
Geographic Variations ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Long Acting

Opioid prescribing data can guide regulation policy by informing trends and types of opioids prescribed and geographic variations. In South Korea, the nationwide data on prescribing opioids remain unclear. We aimed to evaluate an 11-year trend of opioid prescription in South Korea, both nationally and by administrative districts. A population-based cross-sectional analysis of opioid prescriptions dispensed nationwide in outpatient departments between January 1, 2009, and December 31, 2019, was conducted for this study. Data were obtained from the Health Insurance Review & Assessment Service. The types of opioids prescribed were categorized into total, strong, and extended-release and long-acting formulation. Trends in the prescription rate per 1000 persons were examined over time nationally and across administrative districts. There are significant increasing trends for total, strong, and extended-release and long-acting opioid prescriptions (rate per 1000 persons in 2009 and 2019: total opioids, 347.5 and 531.3; strong opioids, 0.6 and 15.2; extended-release and long-acting opioids, 6.8 and 82.0). The pattern of dispensing opioids increased from 2009 to 2013 and slowed down from 2013 to 2019. The rate of opioid prescriptions issued between administrative districts nearly doubled for all types of opioids. Prescription opioid dispensing increased substantially over the study period. The increase in the prescription of total opioids was largely attributed to an increase in the prescription of weak opioids. However, the increase in prescriptions of extended-release and long-acting opioids could be a future concern. These data may inform government organizations to create regulations and interventions for prescribing opioids.

868 Guideline for Discharge Opioid Prescription Management in Adult and Pediatric Burn Patients

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S273-S273 ◽  
Author(s):  
An Bui ◽  
Felicia N Williams ◽  
Lori Chrisco ◽  
Sanja Sljivic ◽  
Rabia Nizamani ◽  
...  
Keyword(s):  
Adult Patients ◽  
Burn Patients ◽  
Prescribing Practices ◽  
Opioid Dependency ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Pain Scores ◽  
Burn Survivors ◽  
Before And After ◽  
Surgical Standard

Abstract Introduction Pediatric and adult burn survivors are at risk for chronic opioid dependency. Conversely, undertreatment of pain can negatively affect mental health and patient compliance. Overtreatment has arguably led to the current opioid legislation. Despite an opioid-limiting mandate, there has been little direction for streamlining prescribing practices and there has been no guideline established to facilitate prescribing practices for burn patients. We evaluated the efficacy of a standard opioid prescribing schedule (SOPS) for surgical patients admitted greater than four days, based on pain scores, in our adult and pediatric burn patients. Methods This was a retrospective review conducted between June 2018 to June 2019 of our prescribing practices compared to a newly established standardized prescribing schedule. All patients admitted to the burn center were included if they had a length of stay longer than 4 days, and were prescribed oxycodone doses between 0-60mg within the last 24 hours of their stay. The primary outcome was amount of oxycodone prescribed upon discharge compared to the doses they received within their last 24hrs before and after the SOPS was established. Results The year before the SOPS was developed, we prescribed an average of 140mg of oxycodone to our pediatric patients upon discharge, even when they used 0mg within 24 hours of discharge. We prescribed an average of 165mg of oxycodone to adult patients who required 0mg 24hrs prior to discharge. We prescribed an average of 200mg to adult patients who required 15mg. We prescribed an average of 235mg to adult patients who required 35mg. We prescribed 310mg to adult patients that required the maximum of 60mg within their last 24 hours. This represented 0% compliance. After adopting the surgical standard opioid prescribing schedule to determine doses, we became 87.5% complaint with all patients and saw no increased in readmissions for pain. Conclusions An institutional guideline for discharge opioid prescribing practices has reduced the number of opioid pills patients take home, and the risk for overtreatment. A Standardized Opioid Prescribing schedule for burn patients is feasible and merits further investigation. Applicability of Research to Practice This study demonstrates the benefits of a standardized prescribing schedule and its applicability to burn patients.

scholarly journals Oral Opioid Prescribing Trends in the United States, 2002–2018

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 3215-3223
Author(s):  
David M Kern ◽  
M Soledad Cepeda ◽  
Anthony G Sena
Keyword(s):  
The United States ◽  
Prior History ◽  
Administrative Claims ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
The Past ◽  
Prescribing Trends ◽  
Over Time

Abstract Objective To conduct a retrospective analysis of sequential cross-sectional data of opioid prescribing practices in patients with no prior history of opioid use. Methods Individuals filling an oral opioid prescription who had 1 year of prior observation were identified from four different administrative claims databases for the period between January 1, 2002, and December 31, 2018: IBM MarketScan® Commercial Database (CCAE), Multi-State Medicaid Database (MDCD), Medicare Supplemental Database (MDCR), and Optum© De-Identified Clinformatics® Data Mart Database. Outcomes included incidence of new opioid use and characteristics of patients’ first opioid prescription, including dispensed morphine milligram equivalent (MME) per day, total MME dispensed, total MME ≥300, and days’ supply of prescription for ≤3 or ≥30 days. Results There were 40,600,696 new opioid users identified. The incidence of new opioid use in the past 17 years ranged from 6% to 11% within the two commercially insured databases. Incidence decreased over time in MDCD and was consistently higher in MDCR. Total MME dispensed decreased in MDCD and increased in CCAE, with no major changes in the other databases. The proportion of patients receiving ≥30-day prescriptions decreased and the proportion of patients receiving ≤3-day prescriptions increased in MDCD, while ≥30-day prescriptions in the Optum database dramatically increased (low of 3.0% in 2003 to peak of 16.9% in 2017). Conclusions Opioid prescribing practices varied across different populations of insured individuals during the past 17 years. The most substantial changes in opioid prescriptions over time have occurred in MDCD, with reductions in use across multiple metrics.

scholarly journals Opioid Prescribing Risk Management Opportunities for the Advance Nurse Practitioners

2021 ◽  
Vol 2 (1) ◽  
pp. 01-06
Author(s):  
Robert Smith
Keyword(s):  
Risk Management ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Opioid Prescription ◽  
Cause Analysis ◽  
Opioid Prescribing ◽  
Root Cause ◽  
Legal Literature ◽  
Opioid Diversion ◽  
Safe Opioid Prescribing

All clinicians are ethically obliged to prescribe responsibly and cautiously to diminish the potential for opioid diversion and to help minimize the growth of the current opioid abuse epidemic. Advance nurse practitioners should establish procedures to better control and limit opioid prescription and develop analgesic regimens to treat pain. The main purpose and goal for this review is to present data congruent with clinical, medical, and legal reports for allowing an appreciation of the possibility of the risk assumed when ordering and prescribing opioids within our podiatry profession. First, the concept and process of risk management as illustrated using a root cause analysis approach will be introduced as well as applying these principles specifically to opioid prescribing will be presented. Then, several examples found in both medical and legal literature documenting the reasons for opioid prescription risk will be presented. Finally, mitigating strategies for safe opioid prescribing will be presented so that mitigation of opioid harm can be possible and realized by the advance nurse practitioner

scholarly journals Administration of and Prescribing Opioids in Emergency Departments: A Retrospective Study

2021 ◽  
Vol 14 ◽  
pp. 1-4
Author(s):  
Casey McNeil ◽  
Alma Habib ◽  
Hayrettin Okut ◽  
Sheryl Beard ◽  
Elizabeth Ablah ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Drug Overdose ◽  
Emergency Departments ◽  
The United States ◽  
Prescribing Practices ◽  
Opioid Prescription ◽  
Opioid Medication ◽  
Opioid Prescribing ◽  
Opioid Administration ◽  
Overdose Deaths

Opioid overdose was a cause of 42,249 deaths in the United States in 2016 (13.3 deaths per 100,000) and contributed to 67.8% of all drug overdose deaths in the USA in 2017.1,2 The rate of drug overdose resulting in death in Kansas in 2016 was 11.8 per 100,000, (333 total drug overdose deaths).2 Emergency departments (EDs) are a key intermediary in opioid prescriptions.  In 2010, 31% of ED visits nationally resulted in an opioid prescription.3 The number of opioid prescriptions from an ED varies greatly even for a single medical indication.  For example, states varied from 40% to 2.8% of patients being prescribed an opioid medication from the ED for ankle sprains among opioid-naive patients treated from 2011 to 2015.4 In Kansas, 35.7% of ankle sprain patients received an opioid prescription from an ED.4  Guidelines for acute pain, including the Alternatives To Opioids protocol (ALTO)5 and the Center for Disease Control and Prevention’s Chronic Pain Guidelines (CDC-CPG)6 are available to guide opioid medication decisions.  The ALTO protocol can be used to guide administration and prescription of analgesics for indications that include headache/migraine, musculoskeletal pain, renal colic, abdominal pain, bone fracture, and joint dislocation. The protocol encourages the use of analgesics such as acetaminophen, ibuprofen, and ketorolac prior to opioid administration.5 The CDC-CPG guides the provider into setting goals for pain control, discussing appropriate risks and benefits with the patients, and setting criteria for minimizing long-term opioid use,6 but defers to the American College of Emergency Physician’s 2012 clinical policy guideline for opioid management of chronic pain in the ED. The ACEP recommends against prescribing opioids for acute exacerbation of chronic pain in the ED [Level C recommendation].7 Adopting opioid prescribing guidelines has drastically reduced opioid prescribing rates in some locations.8  For example, a study performed in both a community and an academic medical center tested the implementation of an opioid prescribing guideline that resulted in a decline of opioid prescriptions from 52.7% to 29.8% of patient visits.8  Even in a hospital with less frequent opioid prescribing practices, adopting guidelines has reduced opioid administration in the ED from 22.5% to 17.7%.9  In 2017, 17 states had adopted opioid prescription guidelines10; however, Kansas is not one of those states. Knowing little of opioid prescribing practices in Wichita, Kansas, the purpose of this study was to identify factors that are associated with opioid administration and prescriptions in EDs in Wichita, Kansas, and to evaluate what methods are used by local prescribers to limit opioid administration and prescription in a locality without an opioid prescribing guideline.

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