As opioid-related deaths continue to rise in the U.S., primary care practices are on the front lines of what has become an unprecedented nationwide epidemic.1,2
No matter the size of your practice or its location—large coastal city or small rural town—illicit prescription opioid use is likely a major concern. In 2015, of the 52,404 Americans who died from a drug overdose, 33,091 (63.1%) involved an opioid.3
You’re on the front lines, but implementing safeguards can be challenging
A recent study found that most patients who screened positive for illicit drug use reported chronic pain.2 Because primary care physicians provide first-line therapies for chronic pain, their prescriptions account for 50% of all opioids dispensed.2
Yet, despite the growing need to address illicit drug use disorders in primary care, few providers do so.2 Why? One study revealed that 35% of physicians have not implemented systems to support the safe initiation, monitoring, and discontinuing of chronic opioid therapy—citing limited time, lack of support staff, institutional resistance, or difficulty accessing and enrolling in a state prescription drug monitoring program (PDMP).4
Another reason may be discomfort. According to a survey conducted by the American Academy of Pain Management and U.S. Pain Foundation, 31% of healthcare professionals said they sometimes feel uncomfortable talking with their patients about prescription drug abuse, and 40% worry that discussions of abuse may damage their relationships with patients.5
While there are many tools that can assist you in having difficult conversations with patients about drug abuse, implementing or enhancing a prescription drug monitoring plan in your practice can help.
Every practice needs a prescription drug monitoring (PDM) plan6
A PDM plan is vital, not only for patient and public health, but also for the health of your practice. More specifically, a PDM plan can:
- Protect your practice and patients
- Improve communication between you and your patients about the risks and benefits of prescription drug therapy
- Increase the safety and effectiveness of drug treatments
- Reduce the risks associated with long-term prescription drug therapy, including substance misuse disorder and overdose
CDC guideline should inform your PDM plan
Recognizing the central role of primary care physicians, the Centers for Disease Control and Prevention (CDC) issued a guideline for prescribing opioids for chronic pain in a primary care setting. Below is a partial list of the guideline’s clinical reminders and recommendations.5
- Evaluate the patient for known risk factors such as illegal drug use or mental health conditions
- Check patients against your state PDMP data for high dosages and prescriptions from other providers
- Conduct urine drug testing before starting opioid therapy and continue testing periodically
- Avoid concurrent benzodiazepine and opioid prescribing whenever possible, as this puts patients at greater risk for potentially fatal overdose
- Refer patient for treatment of opioid use disorder, if needed
- Follow local regulations for managing chronic pain patients taking opioids
- Document your monitoring plans and patient encounters
It’s necessary to keep these recommendations in mind when developing protocol for your practice.
Ready to implement or enhance a PDM plan?
To effectively monitor opioid therapy and adhere to the CDC Guideline for Prescribing Opioids for Chronic Pain, physicians have used a combination of documentation in patient medical records, patient-prescriber pain agreements, state PDMPs, patient education and communication, urine drug testing, and pill counts.4
Quest can also help. Use our broad test menu for chronic pain patients, illicit drugs, and designer drugs so that you always know your patient’s compliance status.
You also have access to toxicologists through Quest’s toxicology hotline—1.877.40.RXTOX (1.877.407.9869)—as well as medMATCH®, a detailed report that indicates if your patient’s results are consistent with the prescribed medication. And we offer further insights in the Quest Diagnostics Health TrendsTM Prescription Drug Monitoring Report.
With the right tools in place, you can help prevent opioid addiction and promote recovery—improving both practice health and patient outcomes.
1. U.S. Department of Health & Human Services. The opioid epidemic: by the numbers. Accessed April 10, 2017. Available at www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf.
2. Bachhuber M, Weiner J, Mitchell J, Samet J. Primary care: on the front lines of the opioid crisis. Penn LDI. 9 Aug 2016. Accessed April 10, 2017. Available at ldi.upenn.edu/brief/primary-care-front-lines-opioid-crisis.
3. Centers for Disease Control and Prevention. Increases in drug and opioid-involved overdose deaths—United States, 2010–2015. Accessed April 26, 2017. Available at www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm.
4. Boston University School of Medicine and Haymarket Medical Education. Physician perceptions on opioid therapy for chronic pain: report on prescribing practices and the role of continuing education on opioids. 2015.
5. Barnet S. Physicians, patients feel ‘uncomfortable’ discussing chronic pain, opioids: 4 survey findings. Becker’s Hospital Review. 30 Jun 2015. Accessed April 12, 2017. Available at www.beckershospitalreview.com/hospital-physician-relationships/physicians-patients-feel-uncomfortable-discussing-chronic-pain-opioids-4-survey-findings.html.
6. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016;65:1-49.