Impact of opioid risk reduction initiatives assessed

There is mounting evidence that risks for opioid overdoses among patients on chronic opioid therapy (COT) increase with high doses. In 2010, state officials in Washington enacted a guideline recommending caution in prescribing opioids at higher doses, defined as a daily morphine equivalent dose of 120 mg or greater. The guideline was mandated for long-term opioid prescribing for chronic non-cancer pain, but excluded hospice and palliative care and management of acute pain after injury or surgery.

Researchers from the Group Health Research Institute in Seattle compared rates of high opioid doses among COT patients statewide and within a health plan. They examined prescribing trends in the plan’s group practice, which implemented an initiative to change physician expectations regarding clinically appropriate and safe opioid dose levels, and compared them with trends among the health plan’s contracted physicians who followed only the state guidelines. A subsequent opioid risk reduction initiative included standards for patient monitoring and urine drug screening, periodic monitoring visits, and modifications to the prescription refill process to prevent urgent refill requests.

The study was conducted from 2006 to 2014 and covered 16,653 COT patients in the group practice and 5,552 in the contracted care settings.

Results showed the percentage of COT patients in the group practice declined after the initiatives to change prescribing expectations. The percent receiving high doses dropped from 16 percent to 6 percent versus a decline from 20 percent to 14 percent in contracted practices, which were exposed to the statewide guidelines but not to the group practice initiative.

“Reductions in high-dose opioid prescribing were substantially greater in the group practice setting that adopted additional initiatives to alter shared physician expectations regarding appropriate COT prescribing,” said Michael Von Korff, lead author, Group Health Research Institute, Seattle.