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Research published in the Journal of Pain assesses initiatives to reduce high-dose chronic opioid therapy (COT) prescribing.
The report, which reviews initiatives implemented by Washington state and a health plan’s group practice, reveals that additional policy measures to change shared expectations of physicians regarding “clinically appropriate” drug levels for long-term management of chronic pain achieved greater reductions in opioid dosing.
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Washington officials in 2010 enacted a guideline recommending caution before prescribing opioids for chronic non-cancer pain at higher doses. The mandate excluded hospice and palliative care and management of acute pain after injury or surgery.
Researchers from the Group Health Research compared rates of high opioid doses among patients on COT throughout Washington and within a health plan. They analyzed how clinicians prescribed in the plan’s group practice, which encouraged prescribers to follow additional measures designed to promote appropriate and safe opioid dose levels, and compared them with trends among the health plan’s contracted physicians who followed only the state guidelines.
The researchers reviewed 16 653 patients undergoing COT in the group practice and 5552 in the contracted care settings.
The percentage of patients on COT receiving ≥120 mg morphine equivalent dose declined from 16.8% to 6.3% in the group practice versus 20.6 to 13.6% among patients undergoing COT of contracted physicians. Among group practice patients on COT, the proportion receiving excess opioid days supplied declined from 24.0% to 10.4%. The reduction among COT patients of contracted physicians: 20.1% to 14.7%.
“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,” study author Michael Von Korff, ofGroup Health Research Institute in Seattle, said in a statement.
