Decline in primary care providers’ prescribing of Schedule II opioids following the implementation of federal and state guidelines
Keywords:opioids, primary care providers, prescription drugs, prescribing practices, overdose, heroin, morphine equivalent daily dosage, addiction
Objective: Prescription opioid misuse represents a social and economic dilemma in the United States. The authors evaluated primary care providers’ (PCPs) prescribing of Schedule II opioids at our institution in Kentucky.
Design: Prospective evaluation of PCPs’ prescribing practices over a 3-year period (October 1, 2014 to September 30, 2017) in an outpatient setting.
Methods: An analysis of Schedule II opioid prescribing following the implementation of federal and state guidelines and evidence-based standards. Special attention focused on Schedule II opioid prescriptions with a quantity > 90, Opana/ Oxycontin, and morphine equivalent daily dosage.
Results: A statistically significant increase in the total number of PCPs and PCPs who prescribed Schedule II opioids was observed, while there was a concurrent significant decrease in the average number of Schedule II opioid pills prescribed per PCP, Schedule II opioid prescriptions per PCP, Schedule II opioid pills prescribed per patient by PCPs, Schedule II opioid prescriptions with a quantity > 90 per PCP, and Opana/Oxycontin prescriptions per PCP. A statistically significant decline in the average morphine equivalent daily dosage of Schedule II opioids per PCP was noted.
Conclusions: This study reports the benefit of incorporating federal and state regulations and institutional evidence-based guidelines into primary care practice to decrease the number of Schedule II opioids prescribed. Further preventive measures include selecting alternative treatments to opioids and reducing the rates of opioid nonmedical use and overdose while maintaining access to prescription opioids when indicated.
Rudd RA, Seth P, David F, et al.: Increases in drug and opioid-involved overdose deaths - United States, 2010-2015. MMWR Morb Mortal Wkly Rep. 2016; 65: 1445-1452.
Guy GP Jr, Zhang K, Bohm MK, et al.: Vital signs: Changes in opioid prescribing in the United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017; 66: 697-704.
Kampman K, Jarvis M: American Society of Addiction Medicine (ASAM) national practice guideline for the use of medications in the treatment of addiction involving opioid use. J Addict Med. 2015; 9: 358-367.
Hughes A, Williams MR, Lipari RN, et al.: Prescription drug use and misuse in the United States: Results from the 2015 national survey on drug use and health. NSDUH Data Review. September 2016. Available at https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR2-2015/NSDUH-FFR2-2015.htm. Accessed October 15, 2018.
Florence CS, Zhou C, Luo F, et al.: The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care. 2016; 54: 901-906.
Compton WM, Jones CM, Baldwin GT: Relationship between nonmedical prescription-opioid use and heroin use. N Engl J Med. 2016; 374: 154-163.
Kentucky Cabinet for Health and Family Services: Kentucky all schedule prescription electronic reporting. Available at https://chfs.ky.gov/agencies/os/oig/dai/deppb/Pages/kasper.aspx. Accessed October 15, 2018.
Freeman PR, Goodin A, Troske S, et al.: Kentucky House Bill 1 impact evaluation. March 2015. Available at https://chfs.ky.gov/agencies/os/oig/dai/deppb/Documents/KentuckyHB1ImpactStudyExecutiveSummary03262015.pdf. Accessed October 15, 2018.
Shields LBE, Nasraty S, Bell AD, et al.: Primary care providers’ prescribing practices of opioid controlled substances. J Opioid Manag. 2016; 12: 397-403.
Shields LBE, Hunsaker JC, Corey TS, et al.: Methadone toxicity fatalities: A review of medical examiner cases in a large metropolitan area. J Forensic Sci. 2007; 52: 1389-1395.
Slavova S, Costich JF, Bunn TL, et al.: Heroin and fentanyl overdoses in Kentucky: Epidemiology and surveillance. Int J Drug Policy. 2017; 46: 120-129.
Chen JH, Hom J, Richman I, et al.: Effect of opioid prescribing guidelines in primary care. Medicine (Baltimore). 2016; 95: e4760.
Harle CA, Bauer SE, Hoang HQ, et al.: Decision support for chronic pain care: How do primary care physicians decide when to prescribe opioids? A qualitative study. BMC Fam Pract. 2015; 16: 48.
Hwang CS, Turner LW, Kruszewski SP, et al.: Primary care physicians’ knowledge and attitudes regarding prescription opioid abuse and diversion. Clin J Pain. 2016; 32: 279-284.
Jamison RN, Scanlan E, Matthews ML, et al.: Attitudes of primary care practitioners in managing chronic pain patients prescribed opioids for pain: A prospective longitudinal controlled trial. Pain Med. 2016; 17: 99-113.
Keller CE, Ashrafioun L, Neumann AM, et al.: Practices, perceptions, and concerns of primary care physicians about opioid dependence associated with the treatment of chronic pain. Subst Abus. 2012; 33: 103-113.
Kennedy-Hendricks A, Busch SH, McGinty EE, et al.: Primary care physicians’ perspectives on the prescription opioid epidemic. Drug Alcohol Depend. 2016; 165: 61-70.
Lagisetty P, Klasa K, Bush C, et al.: Primary care models for treating opioid use disorders: What actually works? A systematic review. PLoS One. 2017; 12: e0186315.
Lasser KE, Shanahan C, Parker V, et al.: A multicomponent intervention to improve primary care provider adherence to chronic opioid therapy guidelines and reduce opioid misuse: A cluster randomized controlled trial protocol. J Subst Abuse Treat. 2016; 60: 101-109.
Foy R, Leaman B, McCrorie C, et al.: Prescribed opioids in primary care: Cross-sectional and longitudinal analyses of influence of patient and practice characteristics. BMJ Open. 2016; 6: e010276.
Pearson AC, Moman RN, Moeschler SM, et al.: Provider confidence in opioid prescribing and chronic pain management: Results of the opioid therapy provider survey. J Pain Res. 2017; 10: 1395-1400.
Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain - United States, 2016. MMWR Recomm Rep. 2016; 65: 1-49.
Murphy JP: Kentucky’s updated controlled substances regulations. Louisville Med. 2018; 65(9): 14-16.
Jones CM, Logan J, Gladden RM, et al.: Vital signs: Demographic and substance use trends among heroin users - United States, 2002-2013. MMWR Morb Mortal Wkly Rep. 2015; 64: 719-725.
Dart RC, Surratt HL, Cicero TJ, et al.: Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. 2015; 372: 241-248.
Unick G, Rosenblum D, Mars S, et al.: The relationship between US heroin market dynamics and heroin-related overdose, 1992-2008. Addiction. 2014; 109: 1889-1898.
Substance Abuse and Mental Health Services Administration: Kentucky meets the gold standard for prescription drug monitoring programs. Available at www.samhsa.gov/capt/tools-learning-resources/kentucky-meets-gold-standard-prescription-drugmonitoring-programs. Accessed October 15, 2018.
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