Opioid Prescribing Habits in a Family Medicine Residency Program for the Management of Non-Cancer Pain

Abstract

Objectives: 1. List components of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain, 2. Describe the prescribing habits of medical residents and attending physicians within a family medicine residency program, 3. Discuss the direction of future research
 Methods: A report was generated for all patients with opioids listed as a medication at Christ Health Center family medicine clinic from July 2016 to June 2017. A total of 153 patients were identified with prescriptions written for chronic non-cancer pain indications. Clinical management via a retrospective chart review was completed utilizing a standardized data collection form centered around four of twelve recommendations within the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain: (1) Avoid concurrent opioid and benzodiazepine prescribing; (2) evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy; (3) perform urine drug testing before starting opioids and consider at least annually; and (4) offer/prescribe medication for opioid use disorder for all patients taking chronic opioids.
 Results: A total of 153 prescriptions were written for chronic indications. The most common indications were chronic back pain (32.0%), unspecified chronic pain (31.4%), and osteoarthritis (9.8%). Average duration of therapy was 26.6 months. Forty-two (27.5%) patients were concurrently receiving benzodiazepine therapy. Eighteen (11.8%) patients performed a drug test before or during therapy. Twenty-two (14.4%) patients had documented discussion with their prescriber evaluating the benefits and harms of their opioid regimens. No patients were prescribed medication for opioid overdose.
 Conclusion: Prescribing habits did not align with the four-guideline recommendations evaluated. The need for provider-focused education on current pain management practice guidelines was identified.
 
 Article Type: Student Project

Evaluation of a Residency Peer-to-Peer Intervention in Opioid Prescribing

“…4 However, opioid prescribing practices of primary care clinicians often do not align with Centers for Disease Control Opioid (CDC) Prescribing Guidelines. 5,6 One family medicine residency program has demonstrated that an educational intervention utilizing guided instruction can be effective in improving residents' guideline adherence. 7,8 Other interventions have been studied in the past, but none have explored the qualitative and quantitative value of an interdisciplinary peer-review intervention in a residency program context.…”