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Multifocal interventions significantly reduce opioid overprescribing
Interventions that addressed patient and public demand, created prescriber awareness and accountability, and established tools for clinical leadership accountability significantly reduced opioid overprescribing, according to findings recently published in JAMA Network Open.
“The prescriber’s role in generating and sustaining opioid abuse has been made clear by studies that link a practitioner’s prescribing patterns to a patient’s likelihood of long-term opioid dependence,” Barry R. Meisenberg, MD, of the department of medicine at Anne Arundel Health System in Maryland, and colleagues wrote.
They analyzed the effects of interventions on opioid prescribing by conducting a quality improvement study and compared the opioid prescriptions for the 6 months prior to the intervention with prescriptions for 16 months after the intervention.
The intervention domains included prescriber accountability and education, increased oversight by measurement of individual prescribers, tools to right-size postoperative discharge prescriptions, cutbacks on default amounts from usual opioid prescription orders, and professionally written patient and public education about opioid risks and alternatives.
Meisenberg and colleagues recorded more than 44,000 clinical encounters per month. They found that vs. baseline, and for each clinical encounter, morphine milligram equivalents dropped 58%, opioid prescriptions decreased 38% and morphine milligram equivalents for each opioid prescription had declined 34% by study’s end (P < .001).
“Because the solutions were initiated as a bundle, it is impossible to determine which interventions were most effective. The magnitude of the achieved reduction stands out in comparison with other less successful efforts in which either policies alone or data sharing without follow-up were used,” Meisenberg and colleagues wrote.
Researchers acknowledged their intervention may not immediately resolve the opioid crisis, but fleeting solutions will likely not stem the tide either.
“We are aware that reducing a community’s opioid reservoir, may, in the short run, increase the number of persons who seek illicit street opioids and thus increase their risk of death. However, we regard cautious prescribing and opioid stewardship as a shared commitment to the long-term health of our community,” Meisenberg and colleagues concluded. – by Janel Miller
Disclosures: The authors report no relevant financial disclosures.