Introduction: In March 2016, the Centers for Disease Control and Prevention issued opioid prescribing guidelines for chronic noncancer pain. In response, in April 2016, the North Carolina Medical Board launched the Safe Opioid Prescribing Initiative, an investigative program intended to limit the overprescribing of opioids. This study focuses on the association of the Safe Opioid Prescribing Initiative with immediate and sustained changes in opioid prescribing among all patients who received opioid and opioid discontinuation and tapering among patients who received high-dose (>90 milligrams of morphine equivalents), long-term (>90 days) opioid therapy.
Methods: Controlled and single interrupted time series analysis of opioid prescribing outcomes before and after the implementation of Safe Opioid Prescribing Initiative was conducted using deidentified data from the North Carolina Controlled Substances Reporting System from January 2010 through March 2017. Analysis was conducted in 2019-2020.
Results: In an average study month, 513,717 patients, including patients who received 47,842 high-dose, long-term opioid therapy, received 660,912 opioid prescriptions at 1.3 prescriptions per patient. There was a 0.52% absolute decline (95% CI= -0.87, -0.19) in patients receiving opioid prescriptions in the month after Safe Opioid Prescribing Initiative implementation. Abrupt discontinuation, rapid tapering, and gradual tapering of opioids among patients who received high-dose, long-term opioid therapy increased by 1% (95% CI= -0.22, 2.23), 2.2% (95% CI=0.91, 3.47), and 1.3% (95% CI=0.96, 1.57), respectively, in the month after Safe Opioid Prescribing Initiative implementation.
Conclusions: Although Safe Opioid Prescribing Initiative implementation was associated with an immediate decline in overall opioid prescribing, it was also associated with an unintended immediate increase in discontinuations and rapid tapering among patients who received high-dose, long-term opioid therapy. Better policy communication and prescriber education regarding opioid tapering best practices may help mitigate unintended consequences of statewide policies.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902466 | PMC |
| http://dx.doi.org/10.1016/j.amepre.2020.09.015 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Impact of exposure to opioids in pregnancy on offspring developmental outcomes in the preschool years: an umbrella review.
BMJ Paediatr Open
January 2025
School of Health Sciences, University of Dundee, Dundee, UK
Background: Early child development sets the course for optimal outcomes across life. Increasing numbers of children worldwide are exposed to opioids in pregnancy and frequently live in environments associated with adverse developmental outcomes. Although multiple systematic reviews have been published in this area, they use different exposures and different types of outcomes.
View Article and Find Full Text PDFAssociation Between Nurses' Comfort and Confidence in Pain Management and Compassion Satisfaction and Fatigue.
Pain Manag Nurs
January 2025
Department of Health Sciences, Towson University, Towson, MD.
Purpose: A current challenge that may exacerbate symptoms of compassion fatigue and compromise the ability to experience compassion satisfaction among nurses is pain management. This study examined the associations between nurses' comfort with administering pain management, confidence in providers' prescribing patterns and reported compassion satisfaction and compassion fatigue (measured as burnout and secondary traumatic stress).
Design: This exploratory study used a survey design to gather primary data from nurses via a convenience sampling method.
Is the Rate of Early mobilization in Hip fracture patients using Alfentanil Better than standard opioid analgesia (REHAB)? A protocol for a prospective cohort study.
Bone Jt Open
January 2025
Division of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
Aims: The primary aim of this study is to compare mobility status of patients receiving oral oxycodone with those receiving subcutaneous alfentanil as analgesic methods prior to mobilization to help physiotherapy compliance after hip fracture surgery. The secondary aims are to assess postoperative pain, health-related quality of life, in-hospital length of stay, total use of analgesia over postoperative days 1 and 2 (POD 1 and POD 2), complication rates within 30 days, and 30-day mortality rates.
Methods: A single-centre, prospective cohort study of 64 patients will be undertaken.
Changing or validating physician opioid prescribing behaviors through audit and feedback and academic detailing interventions in primary care.
Implement Res Pract
January 2025
Institute for Health System Solutions and Virtual Care, Women's College Research and Innovation Institute, Women's College Hospital, Toronto, ON, Canada.
Background: In Ontario, Canada, province-wide initiatives supporting safer opioid prescribing in primary care include voluntary audit and feedback reports and academic detailing. In this process evaluation, we aimed to determine the fidelity of delivery and receipt of the interventions, the observed change strategies used by physicians, potential mechanisms of action, and how complementary the initiatives can be to each other.
Method: Semi-structured interviews were conducted with academic detailers and with physicians who received both interventions.
Academic Detailing Interventions and Evidence-Based Prescribing: A Systematic Review.
JAMA Netw Open
January 2025
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Importance: Academic detailing (interactive educational outreach) is a widely used strategy to encourage evidence-based prescribing by clinicians.
Objective: To evaluate academic detailing programs targeted at improving prescribing behavior and describe program aspects associated with positive outcomes.
Evidence Review: A systematic search of MEDLINE from April 1, 2007, through December 31, 2022, was performed for randomized trials and nonrandomized studies of academic detailing interventions to improve prescribing.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!