Educational intervention for physicians to address the risk of opioid abuse


  • Margaret K. Pasquale, PhD
  • Richard L. Sheer, BA
  • Jack Mardekian, PhD
  • Elizabeth T. Masters, MS, MPH
  • Nick C. Patel, PharmD, PhD
  • Amy R. Hurwitch, PharmD, BCPS
  • Jennifer J. Weber, PharmD, MS, BCPS, CGP, BCACP
  • Anamaria Jorga, MD
  • Carl L. Roland, PharmD, MS



opioid abuse, Medicare population, predictive model, physician intervention


Objective: To evaluate the impact of a pilot intervention for physicians to support their treatment of patients at risk for opioid abuse.

Setting, design and patients, participants: Patients at risk for opioid abuse enrolled in Medicare plans were identified from July 1, 2012 to April 30, 2014 (N = 2,391), based on a published predictive model, and linked to 4,353 opioid-prescribing physicians. Patient-physician clusters were randomly assigned to one of four interventions using factorial design.

Interventions: Physicians received one of the following: Arm 1, patient information; Arm 2, links to educational materials for diagnosis and management of pain; Arm 3, both patient information and links to educational materials; or Arm 4, no communication.

Main outcome measures: Difference-in-difference analyses compared opioid and pain prescriptions, chronic high-dose opioid use, uncoordinated opioid use, and opioid-related emergency department (ED) visits. Logistic regression compared diagnosis of opioid abuse between cases and controls postindex.

Results: Mailings had no significant impact on numbers of opioid or pain medications filled, chronic high-dose opioid use, uncoordinated opioid use, ED visits, or rate of diagnosed opioid abuse. Relative to Arm 4, odds ratios (95% CI) for diagnosed opioid abuse were Arm 1, 0.95(0.63-1.42); Arm 2, 0.83(0.55-1.27); Arm 3, 0.72(0.46-1.13). While 84.7 percent had 1 psychiatric diagnoses during preindex (p = 0.89 between arms), only 9.5 percent had 1 visit with mental health specialists (p = 0.53 between arms).

Conclusions: Although this intervention did not affect pain-related outcomes, future interventions involving care coordination across primary care and mental health may impact opioid abuse and improve quality of life of patients with pain.

Author Biographies

Margaret K. Pasquale, PhD

Research Manager, Comprehensive Health Insights, Inc., Louisville, Kentucky

Richard L. Sheer, BA

Principal Researcher, Comprehensive Health Insights, Inc., Louisville, Kentucky

Jack Mardekian, PhD

Senior Director, Statistics, Pfizer Inc., New York, New York

Elizabeth T. Masters, MS, MPH

Director, Outcomes & Evidence, Pfizer Inc., New York, New York

Nick C. Patel, PharmD, PhD

Research Manager, Comprehensive Health Insights, Inc., Louisville, Kentucky

Amy R. Hurwitch, PharmD, BCPS

Program Manager, Adverse Events|Pharmacy Patient Safety Programs Humana Pharmacy Solutions, Louisville, Kentucky

Jennifer J. Weber, PharmD, MS, BCPS, CGP, BCACP

Managing Pharmacist, Pharmacy Patient Safety Programs Humana Pharmacy Solutions, Louisville, Kentucky

Anamaria Jorga, MD

Medical Director, US Medical Affairs, Pfizer Inc., New York, New York

Carl L. Roland, PharmD, MS

Senior Director, Global Innovative Pharma Business Clinical Sciences and Outcomes and Evidence Pfizer Inc., Durham, North Carolina


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How to Cite

Pasquale, PhD, M. K., R. L. Sheer, BA, J. Mardekian, PhD, E. T. Masters, MS, MPH, N. C. Patel, PharmD, PhD, A. R. Hurwitch, PharmD, BCPS, J. J. Weber, PharmD, MS, BCPS, CGP, BCACP, A. Jorga, MD, and C. L. Roland, PharmD, MS. “Educational Intervention for Physicians to Address the Risk of Opioid Abuse”. Journal of Opioid Management, vol. 13, no. 5, Sept. 2017, pp. 303-1, doi:10.5055/jom.2017.0399.