Are Physicians Doing Enough to Prevent Opioid Misuse and Abuse?

Primary care physicians rarely use opioid risk reduction strategies, even with patients who are at high risk for misuse or abuse.

Researchers from Albert Einstein College of Medicine at Yeshiva University who studied the medical records of more than 1,600 patients who received regular prescription opioids while being treated by office-based primary care physicians for chronic, non-cancer pain have reported finding “lax monitoring even of patients at high risk for opioid misuse, such as those with a history of drug abuse or dependence.” Patients deemed to be at increased risk for opioid misuse or abuse included those who were younger than age 45, had a history of drug or alcohol abuse, used tobacco, or had a mental health disorder.

Their study, titled “Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain,” results of which were published online in the Journal of General Internal Medicine, examined whether patients received urine drug testing and office visits within 30 days of modifying opioid treatment. They also looked at whether patients received multiple early refills of their opioid medication.

Less than one in 10 patients (8%) in the study were screened with urine drug testing, with higher-risk patients more likely (24%) to receive testing. Slightly less than half (49.8%) of all patients made regular office visits, with frequency of visits not affected by risk status of the patient. More than three-quarters of patients (76.6%) were on restricted early medication refills (defined for the study as receiving a refill of their medication more than one week before scheduled). The authors found that patients at higher risk for opioid misuse and abuse were more likely to receive early refills.

In a news release from Albert Einstein College of Medicine at Yeshiva University, lead study author Joanna Starrels, MD, MS, assistant professor of medicine, said that these study results highlight “a missed opportunity for identifying and reducing misuse of prescribed opioids in primary care settings.” Starrels said that although “most primary care physicians are attuned to these problems” many of them have not “put sufficient strategies in place to help reduce risks.”

The fact that primary care physicians in the study “did not increase precautions for patients at highest risk for opioid misuse” should “be a call for a standardized approach to monitoring,” said Starrels. She and the other authors of the study recommend several risk-reduction strategies when prescribing opioid medications for the treatment of chronic, non-cancer pain:

• Standardize a plan of care that includes urine drug testing for all patients
• Zchedule regular face-to-face office visits to evaluate patients’ response to opioids and evidence of misuse
• Stick to a previously agreed-upon refill schedule

HCPLive wants to know:

What steps do you take to minimize the risk of abuse, misuse, and diversion when prescribing opioids to patients with chronic, noncancer pain?

Do you agree that all patients who are prescribed long-term opioids should undergo regular urine drug testing?

Do you use opioid agreements for high-risk patients? If so, how strict are your agreements? Do you follow a zero-tolerance policy?

Do you agree with the study authors that we need a standardized approach to monitoring patients for opioid misuse and abuse?

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