Characterizing Opioid Use at an Academic Family Health Team

Abstract

Background: The escalating use of opioids and related mortality is highly publicized in the media. Clinical practice guidelines have sought to provide direction on the judicious use of opioids; however, primary care providers continue to struggle with how to manage patients on opioid therapy. Objective: The objective of this study was to characterize chronic opioid prescribing patterns for non-cancer pain at an academic family health team and its concordance with the Canadian guideline and the Centers for Disease Control and Prevention guideline. Methods: Electronic medical records for adult patients with non-cancer pain prescribed chronic opioid therapy between January 1, 2015 and November 30, 2016 were retrospectively reviewed. Descriptive statistics assessed concordance to guidelines. Results: One hundred sixty adult patients (< 1% of total population) received chronic (i.e. > 3 months) opioids for non-cancer pain. Fifty-three percent of patients were female; mean age 61 years. The most common pain diagnoses were back pain (45%), osteoarthritis (33%) and chronic pain (24%). Risk factors for opioid overdose or misuse were found in 82% of cases. The following rates of concordance with guideline recommendations were found: 1) total daily doses < 90 mg morphine equivalents (73%), 2) presence of drug contract (42%), 3) follow-up at least four times per year (33%) and 4) annual urine drug screening (3%). Conclusions: The family health team infrequently prescribed chronic opioids. Most prescribed doses were below the recommended watchful dose of morphine equivalents. The respective frequencies of guideline-concordant monitoring processes demonstrate modest adherence to current practice guidelines. However, the data is comparable to similar studies. Opportunities to improve current opioid monitoring practices include more frequent urine drug screening, follow-up, and documentation of opioid treatment agreements. Future interventions should target system-level documentation in order to improve guideline-concordant care of patients on opioid therapy.