Opioid dose risk, clinician and patient characteristics, and adherence to opioid prescribing recommendations in chronic non-cancer pain

Christa Coleman; Robert P. Lennon; James M. Robinson; Wen-Jan Tuan; Nalini Sehgal; Aleksandra E. Zgierska

doi:10.5055/jom.0815

Authors

Christa Coleman, PsyD, MSCP https://orcid.org/0000-0003-4255-5592
Robert P. Lennon, MD, JD
James M. Robinson, PhD
Wen-Jan Tuan, DHA, MPH, MS
Nalini Sehgal, MD
Aleksandra E. Zgierska, MD, PhD

DOI:

https://doi.org/10.5055/jom.0815

Keywords:

clinician adherence, long-term opioid therapy, chronic noncancer pain

Abstract

Objective: This study aims to assess associations between morphine-equivalent daily dose (MEDD) of opioids, clinician and patient characteristics, and prescriber adherence to guidelines for long-term opioid therapy (LTOT) in chronic noncancer pain (CNCP) and to elucidate potential relationships associated with increased-risk opioid prescribing.

Design: Retrospective cross-sectional study.

Setting: Academic health system's 33 primary care clinics.

Patients: Adults (≥18 years old) prescribed LTOT (10 + outpatient prescriptions in the past year) for CNCP.

Main outcome measure(s): Electronic health record data on prescribed opioids (for MEDD), clinician/patient characteristics, and adherence rates to LTOT guideline-concordant recommendations.

Results: A total of 2,738 patients were eligible, 61.6 percent Lower, 15.7 percent Moderate, and 22.7 percent Higher Risk MEDD (<50, 50-89, and ≥90 mg/day, respectively). Higher MEDD correlated (p < 0.001) with Medicare insurance, current cigarette smoking, higher pain intensity and interference scores, and the presence of opioid use disorder diagnoses. Male clinicians more frequently prescribed (p < 0.001) and male patients were more likely to be prescribed (p < 0.001) higher MEDD compared to their female counterparts. Higher Risk MEDD was associated with higher coprescribed benzodiazepines (p = 0.015), lower depression screening (p = 0.048), urine drug testing (p = 0.003), comparable active treatment agreement (p = 0.189), opioid misuse risk screening (p = 0.619), and prescription drug monitoring checks (p = 0.203).

Conclusions: This study documented that higher MEDD was associated with risks of worse health outcomes without improved adherence to opioid prescribing guideline recommendations. Enhanced clinician awareness of factors associated with MEDD has the potential to mitigate LTOT risks and improve overall patient care.

Author Biographies

Christa Coleman, PsyD, MSCP

Assistant Professor, Departments of Psychiatry and Behavioral Health, and Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, Pennsylvania

Robert P. Lennon, MD, JD

Associate Professor, Department of Family and Community Medicine, Penn State College of Medicine, Hershey; Affiliate Faculty, Penn State Law, State College, Pennsylvania

James M. Robinson, PhD

Center for Health Systems Research and Analysis, University of Wisconsin-Madison, Madison, Wisconsin

Wen-Jan Tuan, DHA, MPH, MS

Assistant Professor, Department of Family and Community Medicine, and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania

Nalini Sehgal, MD

Professor, Department of Orthopedic & Rehabilitation Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin

Aleksandra E. Zgierska, MD, PhD

Professor, Departments of Family and Community Medicine, Public Health Sciences, and Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, Pennsylvania

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