Improve Prescribing Practices
Insurance Company Practices Contribute to Over-Prescription of Opioids
Prescribing should take Risk Factors into Consideration
Opioid Naive Patients
Multiple studies (five of which are referenced in this UpToDate article) have reported an increased risk of new persistent opioid use after prescription of opioids for acute pain in opioid naïve patients[3]
That article also states: "Importantly, post-surgical opioid prescription in opioid naïve patients is also associated with an increase in overdose and misuse."
Other Risk Factors
CDC Guidelines for Prescribing Opioids for Chronic Pain
- Non-opioid therapy is preferred for chronic pain outside of active cancer, palliative, and end-of-life care.
- When opioids are used, the lowest possible effective dosage should be prescribed to reduce risks of opioid use disorder and overdose.
- Providers should always exercise caution when prescribing opioids and monitor all patients closely.
The idea is to encourage doctors to be more cautious about prescribing opioids, making them less likely to distribute the drugs to patients who are prone to addiction or don't really need the medication. (The evidence on whether opioid painkillers can even treat chronic pain is weak at best.) And if doctors take up the recommendations, they could help stop one of the deadliest drug epidemics in US history.[5]
Source:https://www.cdc.gov/drugoverdose/prescribing/guideline.html
Ways to Improve Prescribing Practices
Improve Patient Education on the Risks of Using Opioids and the Alternatives
Use Tools Built into EHRs
EHRs are adding tools to support better prescribing practices for opioids.
MEDITECH is one example with ther new (2019) module, the Opioid Stewardship Toolkit
Adopt Policies That Compel Physicians To Utilize PDMPs
- Until states began requiring physicians to use prescription drug-monitoring programs, fewer than 35 percent of medical professionals used the tracking systems to identify patients who may be at risk for addiction and overdose. Now, in states that require doctors to consult PDMPs, physician usage rates exceed 90 percent.[6]
- Overall opioid prescribing has declined in those states as well, as have drug-related hospitalizations and overdose deaths. States also are seeing a rise in addiction treatment as more doctors refer patients to treatment after discovering they are taking painkillers from multiple sources and are likely addicted.
- In 2010, Colorado, Delaware, Louisiana, Nevada and Oklahoma were the first states to require doctors and other prescribers to search patients’ drug histories before prescribing opioid painkillers, sedatives or other potentially harmful and addictive drugs. By December 2016, at least 31 states were requiring prescriber use of PDMPs.
- This year (2017), eight more states — Alabama, Alaska, California, Florida, Michigan, South Carolina, Texas and Wisconsin — implemented policies requiring doctors to not only log in to the state’s prescription drug-tracking system before prescribing a controlled substance, but also to analyze each patient’s history of drug use, and if necessary, limit prescription renewals for opioids and other potentially addictive or dangerous medications.[7]
Improve Patient Education on the Risks of Opioids
An new technology-enhanced approach to patient understanding and education is available through DrProveIt.com
Approaches to Reduce Inappropriate Prescriptions
Ohio's Safety Checkpoints
[1]
GuideMed
Scorecard Building
Potential Objective Details
Potential Measures and Data Sources
Potential Actions and Partners
Resources to Investigate
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