A Research Agenda for Enhancing Appropriate Opioid Prescribing in Primary Care

Abstract

The challenges facing patients and providers in managing ongoing opioid analgesic therapy for chronic pain are complex. Benefit of long-term opioid therapy, for which there are scant data, must be balanced against myriad potential undesired outcomes, including safety problems, ranging from mild toxicities to overdose and death; inadequate efficacy, which may mean continued patient suffering and unwarranted exposure to toxicities; and misuse of these potent medications. To help patients and providers navigate these challenges and optimize therapy, we present a research agenda in which we first characterize appropriate ongoing opioid prescribing and then describe three areas where quality improvement work is needed: 1) developing brief validated measures of patient-reported safety, efficacy, and misuse that improve outcomes; 2) designing evidence-based algorithms to guide changes in therapy when issues related to safety, efficacy or misuse are identified; and 3) promoting use of patientcentered, multi-modal treatment plans.KEY WORDS: opioid analgesics; medication safety; provider behavior; quality of care.

Opioid Prescribing: Can the Art Become More Science?

“…3 They suggest key areas of research aimed at reducing inappropriate prescribing. They begin by characterizing "appropriate ongoing opioid prescribing" and then identify quality improvement priorities, including: 1) developing brief, patient-administered screening checklists that incorporate items related to safety, efficacy and misuse; 2) developing treatment pathways to manage safety-related issues, low efficacy and problems related to misuse; and 3) promoting patient-centered, multimodal treatment plans.…”

“…Becker and colleagues 3 have suggested a useful research agenda for evidence-based strategies to reduce inappropriate prescribing. However, many of the complexities and challenges of opioid prescribing are nuanced and involve assessing and managing subjective benefits, risks and harms and being skilled in patient communication strategies.…”

Institutional Research Agenda Execution Through Undergraduate Thesis Output

“…University agendas, for example, may emerge from specific teams or leading researchers who have identified more nuanced research approaches for a particular field (Becker et al, 2013;Gedajlovic, Honig, Moore, Payne, & Wright, 2013). Assessment through the faculty and researcher is one part.…”

Strategies to Identify and Reduce Opioid Misuse Among Patients with Gastrointestinal Disorders: A Systematic Scoping Review

“…These recommendations promote a shift in focus and call for innovative approaches such as coordinated interventions that meaningfully engage all stakeholders involved. Becker and colleagues have recommended developing validated ways to monitor safety, efficacy and misuse; creating clear protocols to guide changes in therapy when issues of safety, efficacy or misuse are identified; and using patient-centered treatment plans that emphasize enhanced patient-provider communication around opioid safety [16]. In their recent study, Levy et al proposed engaging individual medical care specialties with high opioid prescription rates in efforts to develop strategies that effectively reduce inappropriate opioid use [5].…”