Curbing Prescription Opioid Abuse Is a Group Effort

With hospitalizations and emergency room visits related to prescription opioid pain medicines on the rise, Group Health Cooperative launched an initiative to make prescribing safer while improving care for patients with chronic pain.

According to a study published in the August issue of Health Affairs, fatal overdoses involving prescribed opioids tripled in the United States between 1999 and 2006, climbing to almost 14,000 deaths annually—more than cocaine and heroin overdoses combined. Excluding people with cancer and those in end-of-life care, about 4% of US adults now use prescription opioids long term.

In the first 9 months of Group Health’s project, clinicians at the Seattle-based integrated health system had developed and documented care plans for almost 6000 patients, 85% of whom were receiving long-term opioid therapy for chronic non-cancer pain. The researchers are evaluating the initiative’s effects on care in hopes that it can guide national efforts to stem the epidemic of prescription drug abuse.

In January 2010, Group Health Research Institute senior investigator Michael Von Korff, ScD, and colleagues published the first-ever study on overdose risk by dose among patients receiving prescribed opioids for chronic non-cancer pain. The study, which was published in the Annals of Internal Medicine, linked higher risk of fatal and nonfatal overdose to higher daily dose prescribed. The research also showed that Group Health had been prescribing more opioids for chronic non-cancer pain over time, marking a twofold increase from 1997 to 2005.

Group Health launched a major primary care-based initiative later in 2010 to enhance opioid prescribing safety. Led by Group Health Medical Director of Primary Care Claire Trescott, MD, the initiative aims to standardize use of opioids for chronic non-cancer pain, without creating undue restrictions on clinically appropriate opioid prescribing.

Using Lean management principles, Dr. Trescott worked with primary care doctors, nurses, pharmacists, pain specialists, and other clinical leaders to formulate new guidelines and related practice changes, which include creating standardized care plans for all patients receiving opioids long-term for chronic non-cancer pain.

"Our new opioid care plans specify one responsible prescribing physician, clarify expectations for monitoring and refills, outline treatment goals, and explain risks and side effects of long-term opioid use," said Dr. Trescott in a statement.

The individualized plans are created for each patient receiving opioids for 90 days or more. The clinician actively involves patients in the plan development and education on the risks and potential benefits of long-term opioid use, and prescription refill processes are modified to avert problems when patients seek a refill on short notice or run out of medication over a weekend. Periodic monitoring visits with providers are scheduled, depending on dosage level and risk factors.

"We see impressive changes when our delivery system, research institute, and foundation collaborate—pooling our knowledge, skills, and resources," Dr. Von Korff said. "It's a powerful example of how a learning health care system can act quickly to address important problems in health care."