Healthcare providers at Veterans Affairs (VA) centers cite time constraints, logistic constraints, and interpersonal challenges as unique barriers to adherence with practice guidelines when treating patients on long-term opioid therapy, according to a study published in Pain Medicine. Urine drug testing, patient education, and access to alternative therapies for pain management are advanced as worthwhile strategies for addressing opioid-related safety concerns in patients receiving care at VA centers.
Primary care providers from 22 VA centers who had prescribed long-term opioid therapy for chronic noncancer pain to ≥1 patient were interviewed (n=24). Qualitative interviews were used to identify practice patterns and treatment initiatives providers used to address potential misuse of prescription opioids in their patients and to determine the initiatives used by providers to meet opioid safety requirements, including the strategies they used to incorporate new treatment guidelines into their daily practice.
The healthcare practitioners consulted were physicians (75%), nurses (17%), and physician assistants (4%). The most common barriers to meeting compliance with new opioid-related treatment policies while reducing the risk for opioid-related harm included interpersonal constraints between patients and providers, resource constraints, geographic constraints, logistic constraints, and cultural constraints. Urine drug testing was reportedly used by all providers, with nurses reporting extensive time investment for this clinical strategy.
Opioid agreements and informed consents for long-term opioid therapy were also reported strategies throughout the cohort, however, participants cited time constraints as a definite challenge with this approach. Engaged pharmacists who ran classes on opioid risks represented an additional resource seeking to reduce opioid-related harm. Increasing patients’ knowledge and access to nonpharmacologic alternatives to opioid medications, including physical therapy and acupuncture, were also reported to lessen providers’ and patients’ reliance on these analgesics.
Study limitations the small sample size, and the reliance on questionnaire data.
“[P]roviders should consider cultivating alternative resources for pain treatment, engaging in collaborative, interdisciplinary efforts, and, more broadly, seeking creative solutions to the difficult clinical challenges posed by patients with chronic pain,” noted the study authors.
Wyse JJ, Ganzini L, Dobscha SK, Krebs EE, Zamudio J, Morasco BJ. Clinical strategies for the treatment and management of patients prescribed long-term opioid therapy [published online November 2, 2018]. Pain Med. doi: 10.1093/pm/pny211