Opioid Analgesics in Pain Management Responsible Prescribing for Our Injured Workers Stephen T. Woods M.D.
OPIOID MANAGEMENT TOOLS Pharmacy Benefits Program o Monitoring utilization Providers o Appropriate prescribing
Opioid Utilization Management Tools Pharmacy Benefits Program o Closed Formulary o Opioid Trending Report o Controlled Substance Monitoring Program o Point of Service Edits o Drug Utilization Review o Ohio Automated Rx Reporting System (OARRS) monitoring o Medication Therapy Management (MTM)
Opioid Prescribing Management Tools o Risk assessment tool o OARRS o Urine Drug Screen (UDS) o Patient Pain Treatment Agreement (Pain Contract) o 4 “A”s of Pain Management • Activities of Daily Living (ADLs) • Adverse effects • Analgesia • Aberrant behavior
Governor’s Cabinet Opiate Action Team (GCOAT) Professional Education Workgroup Reforming Prescribing Practices Committee DRAFT RECOMMENDATIONS 01/04/2013
Context o Patients with chronic, non-terminal pain
Trigger o ≥ 80 mg morphine equivalent dose (MED) o Average daily dose (over a 90-day period) o OARRS database o #16 Vicodin/Norco 5mg tabs o #11 Percocet 5mg tabs
Prescriber Actions (Required) o Informed consent o Written safety information o Check OARRS o Pain treatment agreement o Document 4 “A”s
Prescriber Actions (Suggested) o Reassess pain etiology (exam/Ddx) o Assess addiction risk/mental health concerns o Reassess patient goals o Revisit treatment options o Accountability plan (pill counts, sponsor supervision) o Taper, wean, rotate meds o Referral to pain mgt or other or 2 nd opinion
Washington State Dept. of Labor & Industries Guidelines for Prescribing Opioids to Treat Pain in Injured Workers
“Good Stuff. If every state, every carrier, every employer enforced (or perhaps were allowed to enforce) such guidelines, we could eliminate a significant portion of the opioid problem in comp.” Gavin, Michael. (2013 Jan). New Opioid Guidelines: Well Done Washington. Workers’ Compensation Institute360.
Why? o Functionally based o Tailored to work comp o Proactive o Case definition for discontinuing COT o Rule
Clinically Meaningful Improvement in Function o Function as metric in measuring success o Function drives utilization o Example: Does it make sense to accept the risk of the treatment without the reward of function and return to work?
Triggers o Time based • Acute 0-6 weeks • Sub-acute 6-12 weeks • Chronic >12 weeks o Implementation of tools escalates with each phase. o Opportunities to wean start early o Chronic treatment limited to 120 MEDs
Discussion o Case Examples o Question and answer
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