The 2016 CDC Opioid Prescribing Guideline for Chronic Pain: Unintended Consequences and a Revision on the Horizon

ASRA News ◽  
2021 ◽  
Vol 46 (1) ◽  
Author(s):  
Beth Darnall
Keyword(s):  
Chronic Pain ◽  
Unintended Consequences ◽  
Opioid Prescribing

Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711581
Author(s):  
Charlotte Greene ◽  
Alice Pearson
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Practice Guidelines ◽  
Best Practice ◽  
Evidence Base ◽  
High Dose ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Best Practice Guidelines

BackgroundOpioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018.AimAn audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines.MethodA search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine’s best-practice guidelines were used.ResultsDemographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids. Indications: back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented. Review: 56% 4-week, 70% past year.ConclusionOpioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals.

How opioid prescribing policies influence primary care clinicians’ treatment decisions and conversations with patients with chronic pain

2021 ◽  
Vol 17 (6) ◽  
pp. 499-509
Author(s):  
Elizabeth C. Danielson, PhD ◽  
Christopher A. Harle, PhD ◽  
Sarah M. Downs, MPH ◽  
Laura Militello, MA ◽  
Olena Mazurenko, MD, PhD
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Treatment Decisions ◽  
Healthcare Organizations ◽  
Chronic Noncancer Pain ◽  
Opioid Prescribing ◽  
Prevention Guideline ◽  
Multistep Process ◽  
Primary Care Clinicians ◽  
Noncancer Pain

Objective: The 2016 Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain aimed to assist primary care clinicians in safely and effectively prescribing opioids for chronic noncancer pain. Individual states, payers, and health systems issued similar policies imposing various regulations around opioid prescribing for patients with chronic pain. Experts argued that healthcare organizations and clinicians may be misapplying the federal guideline and subsequent opioid prescribing policies, leading to an inadequate pain management. The objective of this study was to understand how primary care clinicians involve opioid prescribing policies in their treatment decisions and in their conversations with patients with chronic pain.Design: We conducted a secondary qualitative analysis of data from 64 unique primary care visits and 87 post-visit interviews across 20 clinicians from three healthcare systems in the Midwestern United States. Using a multistep process and thematic analysis, we systematically analyzed data excerpts addressing opioid prescribing policies.Results: Opioid prescribing policies influenced clinicians’ treatment decisions to not initiate opioids, prescribe fewer opioids overall (theme #1), and begin tapering and discontinuation of opioids (theme #2) for most patients with chronic pain. Clinical precautions, described in the opioid prescribing policies to monitor use, were directly invoked during visits for patients with chronic pain (theme #3).Conclusions: Opioid prescribing policies have multidimensional influence on clinician treatment decisions for patients with chronic pain. Our findings may inform future studies to explore mechanisms for aligning pressures around opioid prescribing, stemming from various opioid prescribing policies, with the need to deliver individualized pain care.

scholarly journals Improving Residents' Safe Opioid Prescribing for Chronic Pain Using an Objective Structured Clinical Examination

2016 ◽  
Vol 8 (3) ◽  
pp. 390-397 ◽  
Author(s):  
Daniel P. Alford ◽  
Brittany L. Carney ◽  
Belle Brett ◽  
Sharon J. Parish ◽  
Angela H. Jackson
Keyword(s):  
Internal Medicine ◽  
Chronic Pain ◽  
Clinical Examination ◽  
Academic Medical Center ◽  
Objective Structured Clinical Examination ◽  
Opioid Prescribing ◽  
Internal Medicine Residents ◽  
Number Of Patients ◽  
Safe Opioid Prescribing ◽  
And Control

ABSTRACT  Internal medicine residents care for a sizable number of patients with chronic pain. Programs need educational strategies to promote safe opioid prescribing.Background  To describe a safe opioid prescribing education program utilizing an objective structured clinical examination (OSCE) and report the resulting impact on residents' knowledge, confidence, and self-reported practices.Objective  Using a quasi-experimental design, 39 internal medicine residents from an urban academic medical center were assigned to 1 of 4 groups: 1-hour lecture only, lecture followed by immediate OSCE, lecture followed by 4-month delayed OSCE, and control. Safe opioid prescribing knowledge, confidence, and self-reported practices were assessed at baseline and at 8 months.Methods  At 8 months, knowledge, confidence, and self-reported practices improved in the control and in all 3 intervention groups. The immediate OSCE group had the greatest improvements in combined confidence scores within group (0.74, P = .01) compared to controls (0.52, P = .05), using a 5-point scale. This group also had the greatest improvement in self-reported practice changes (1.04, P = .04), while other groups showed nonsignificant improvements—delayed OSCE (0.43, P = .44), lecture only (0.66, P = .24), and control (0.43, P = .19).Results  Safe opioid prescribing education that includes a lecture immediately followed by an OSCE had an impact on residents' confidence and self-reported practices greater than those for delayed OSCE or lecture only groups. There was no difference in knowledge improvement among the groups. Lecture followed by an OSCE was highly regarded by residents, but required additional resources.Conclusions

scholarly journals Barriers and facilitators to implementing changes in opioid prescribing in rural primary care clinics

2020 ◽  
Vol 4 (5) ◽  
pp. 425-430
Author(s):  
Michael L. Parchman ◽  
Brooke Ike ◽  
Katherine P Osterhage ◽  
Laura-Mae Baldwin ◽  
Kari A Stephens ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Rural Areas ◽  
Building Blocks ◽  
Rural Practice ◽  
Barriers And Facilitators ◽  
External Support ◽  
Rural Setting ◽  
Opioid Prescribing ◽  
Patient Resources

AbstractBackground:Opioids are more commonly prescribed for chronic pain in rural settings in the USA, yet little is known about how the rural context influences efforts to improve opioid medication management.Methods:The Six Building Blocks is an evidence-based program that guides primary care practices in making system-based improvements in managing patients using long-term opioid therapy. It was implemented at 6 rural and rural-serving organizations with 20 clinic locations over a 15-month period. To gain further insight about their experience with implementing the program, interviews and focus groups were conducted with staff and clinicians at the six organizations at the end of the 15 months and transcribed. Team members used a template analysis approach, a form of qualitative thematic analysis, to code these data for barriers, facilitators, and corresponding subcodes.Results:Facilitators to making systems-based changes in opioid management within a rural practice context included a desire to help patients and their community, external pressures to make changes in opioid management, a desire to reduce workplace stress, external support for the clinic, supportive clinic leadership, and receptivity of patients. Barriers to making changes included competing demands on clinicians and staff, a culture of clinician autonomy, inadequate data systems, and a lack of patient resources in rural areas.Discussion:The barriers and facilitators identified here point to potentially unique determinants of practice that should be considered when addressing opioid prescribing for chronic pain in the rural setting.

scholarly journals Provider confidence in opioid prescribing and chronic pain management: results of the Opioid Therapy Provider Survey

2017 ◽  
Vol Volume 10 ◽  
pp. 1395-1400 ◽  
Author(s):  
Amy Pearson ◽  
Rajat Moman ◽  
Susan Moeschler ◽  
Jason Eldrige ◽  
W. Michael Hooten
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Opioid Therapy ◽  
Chronic Pain Management ◽  
Opioid Prescribing ◽  
Provider Survey
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