Prescribing Patterns and Use of Risk-Reduction Tools After Implementing an Opioid-Prescribing Protocol
Open accessAbstract
Background: The literature on results from primary care–based opioid-prescribing protocols is small and results have been mixed. To advance this field, we evaluated whether opioid prescribing changed after a comprehensive protocol was implemented and whether change was associated with the number and type of risk reduction tools adopted. Methods: Electronic medical record data were obtained for 2607 patients. Demographics, Patient Health Questionnaire–9 scores, body mass index, and utilization levels of protocol elements were measured for 24 months prior and 18 months post implementation of an opioid-prescribing protocol within a federally qualified health center. χ2 and t-tests were computed to estimate change in opioid prescribing, morphine-equivalent dose, comedication prescribing, and number and type of protocol elements utilized. Results: The opioid protocol was associated with an increase in urine drug screens from 18.3% to 26.8% from pre to postimplementation (P < .0001). There was no significant increase in opioid treatment agreements. Tramadol (21.4% to 16.8%, P = .0006) and antidepressant (56.0% to 51.6%, P = .012) prescribing significantly decreased. Total opioid prescriptions and maximum morphine-equivalent doses were similar from pre to postimplementation. Protocol elements were more often used when patients had a higher opioid dose and were receiving benzodiazepines. Conclusions: Implementing a multi-faceted opioid-prescribing protocol was not associated with change in number or dose of opioid prescriptions but was associated with greater use of urine drug screens, and risk reduction tools were used more often in high-risk patients. Implementation research is needed to identify barriers to maximizing adherence to opioid protocols.
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Prior studies have shown that neither opioid risk reduction tools nor cognitive behavioral therapy reduce the use of opioid medications.
“Prior studies have shown that neither opioid risk reduction tools nor cognitive behavioral therapy (CBT) will reduce the use of opioid medications.”
From Decision Support and Behavioral Health for Reducing High-Dose Opioids in Comorbid Chronic Pain, Depression and Anxiety: Stepped-Wedge Cluster Randomized Trial (2024) · cites this paper as [33]
The Abstract reports that this study's multifaceted opioid-prescribing protocol was not associated with a change in the number or dose of opioid prescriptions. That supports the risk-reduction portion only in this specific setting: it does not establish that risk-reduction tools generally cannot reduce opioid use. The paper does not address cognitive behavioral therapy, and it also describes prior studies in which risk-reduction strategies were associated with dose reduction or discontinuation. (LLM, conf=0.86)
Experimental — accuracy not yet measuredProtocol elements of an opioid-prescribing risk reduction tool were most often used in patients with higher opioid dosage and co-prescriptions for benzodiazepines.
“Breeden etal. reported in a study of an opioid-prescribing risk reduction tool that protocol elements were most often used in patients with higher opioid dosage and co-prescriptions for benzodiazepines.”
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- Authors
- Breeden, M. A., Jacobs, C. K., Witthaus, M., Salas, J., Everard, K. M., Penton, E., & Scherrer, J. F.
- Affiliations
- Saint Louis University (US)
- Venue
- The Journal of the American Board of Family Medicine
- Published
- 2020-01
- Volume
- 33
- Issue
- 1
- Pages
- 27-33
- ISSN
- 1557-2625 (ISSN-L)
- 1558-7118
- OpenAlex
- W3000520695
- Cited by
- 8
- References
- 20
- Citations by year
- 2024: 2 · 2022: 4 · 2020: 2
- FWCI
- 1.12
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- The Journal of the American Board of Family Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- opioid prescribing, prescribing protocols, urine drug testing, morphine milligram equivalents, tramadol, antidepressant prescribing, benzodiazepines, federally qualified health centers, primary care, protocol adherence
- MeSH terms
- Adult, Analgesics, Opioid, Female, Humans, Male, Middle Aged, Opioid-Related Disorders, Practice Patterns, Physicians', Primary Health Care, Surveys and Questionnaires, Retrospective Studies, Risk Assessment, Chronic Pain, Pain Management
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