Successful interventions in decreasing oxycodone CR prescriptions within an underserved population
Keywords:opioids, oxycontin, oxycodone, Controlled Substance User Agreement, structured medical management of pain
Objective: To use fundamental population health and Patient Centered Medical Home guidelines to create an effective intervention that would decrease the quantity of inappropriate oxycodone controlled release (CR) prescriptions within an uninsured population.
Design: This was a prospective interventional study.
Patients, participants: Patients seen in the newly formed University of Florida Community Health and Family Medicine Department Total Care Clinic, for chronic nonmalignant pain. This clinic was designed to serve the uninsured patients of Jacksonville, FL.
Interventions: A structured, step-wise pain management protocol was introduced and implemented, and an improved Controlled Substance User Agreement was created and implemented. Pharmacists and primary care providers collaborated on care.
Main outcome measure(s): The primary study outcome measures were the number of oxycodone CR prescriptions over an 8-month period.
Results: At the initiation of the program, the authors averaged over 40 oxycodone CR prescriptions per month. After 3 months, the number of prescriptions dropped to an average of 10 per month, a 75 percent decrease. More importantly, the number of oxycodone CR tablets saw a corresponding 75 percent drop from over 2,500 tablets per month to approximately 600 per month. Of course, the authors were concerned that the reduction of oxycodone CR may lead to increases in the use of other opioids. However, trends for hydrocodone/acetaminophen also showed a reduction in total usage as well as all other long-acting opioids. In addition, patient satisfaction did not change significantly, and no significant complaints from patients regarding this specific change were received.
Conclusions: By implementing criteria for oxycodone CR prescribing in an innovative, comprehensive, and unified patient-centered practice model, the authors saw a significant decrease in the number of oxycodone CR tablets prescribed per month and also a decrease in total prescriptions per month.
US Department of Veteran Affairs: Criteria for Use of Controlled-release Oxycodone. Available at http://www.pbm.va.gov/clinicalguidance/criteriaforuse/OxycodoneCRCriteriaforUseandTreatmentAlgorithm.pdf. Accessed June 2, 2015.
City of Jacksonville: Available at http://www.coj.net/mayor.aspx. Accessed September 1, 2013.
Oxycontin (oxycodone HCL extended-release) [package insert]. Stamford, CT: Purdue Pharma L.P., July 2012.
Gold Standard, Inc.: Oxycodone. Clinical Pharmacology [database online]. Available at http://www.clinicalpharmacology.com. Accessed November 26, 2012.
Chou R, Fanciullo GJ, Fine PG, et al.: Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009; 10(2): 113-130.
Knotkova H, Fine PG, Portenoy RK: Opioid rotation: The science and the limitations of the equianalgesic dose table. J Pain Symptom Manage. 2009; 38(3): 426-439.
Vissers KC, Besse K, Hans G, et al.: Opioid rotation in the management of chronic pain: Where is the evidence? Pain Pract. 2010; 10(2): 85-93.
Kahan M, Mailis-Gagnon A, Wilson L, et al.: Canadian guideline for safe and effective use of opioids for chronic noncancer pain: Clinical summary for family physicians. Part 1: General population. Can Fam Physician. 2011; 57(11): 1257-1266, e407-e418.
Kahan M, Wilson L, Mailis-Gagnon A, et al.: Canadian guideline for safe and effective use of opioids for chronic noncancer pain: Clinical summary for family physicians. Part 2: Special populations. Can Fam Physician. 2011; 57(11): 1269-1276, e419-e428.
Manchikanti L, Abdi S, Atluri S, et al.: American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part I—Evidence assessment. Pain Physician. 2012; 15(3 suppl): S1-S65.
Manchikanti L, Abdi S, Atluri S, et al.: American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part 2—Guidance. Pain Physician. 2012; 15(3 suppl): S67-S116.
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