Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain
- Joanna L. StarrelsAffiliated withDivision of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center Email author
- , William C. BeckerAffiliated withYale University School of Medicine
- , Mark G. WeinerAffiliated withUniversity of Pennsylvania School of Medicine
- , Xuan LiAffiliated withDivision of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center
- , Moonseong HeoAffiliated withDivision of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center
- , Barbara J. TurnerAffiliated withUniversity of Texas Health Science Center and University Health System
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Experts recommend close oversight of patients receiving opioid analgesics for chronic non-cancer pain (CNCP), especially those at increased risk of misuse. We hypothesized that physicians employ opioid risk reduction strategies more frequently in higher risk patients.
Retrospective cohort using electronic medical records.
Patients on long-term opioids (≥3 monthly prescriptions in 6 months) treated for CNCP in eight primary care practices.
We examined three risk reduction strategies: (1) any urine drug test; (2) regular office visits (at least once per 6 months and within 30 days of modifying opioid treatment); and (3) restricted early refills (one or fewer opioid refills more than a week early). Risk factors for opioid misuse included: age <45 years old, drug or alcohol use disorder, tobacco use, or mental health disorder. Associations of risk factors with each outcome were assessed in non-linear mixed effects models adjusting for patient clustering within physicians, demographics and clinical factors.
Of 1,612 patients, 8.0% had urine drug testing, 49.8% visited the office regularly, and 76.6% received restricted (one or fewer) early refills. Patient risk factors were: age <45 (29%), drug use disorder (7.6%), alcohol use disorder (4.5%), tobacco use (16.1%), and mental health disorder (48.4%). Adjusted odds ratios (AOR) of urine drug testing were significantly increased for patients with a drug use disorder (3.18; CI 1.94, 5.21) or a mental health disorder (1.73; CI 1.14, 2.65). However, the AOR for restricted early refills was significantly decreased for patients with a drug use disorder (0.56; CI 0.34, 0.92). After adjustment, no risk factor was significantly associated with regular office visits. An increasing number of risk factors was positively associated with urine drug testing (p < 0.001), but negatively associated with restricted early refills (p = 0.009).
Primary care physicians’ adoption of opioid risk reduction strategies is limited, even among patients at increased risk of misuse.
KEY WORDSopioid misuse chronic pain urine drug testing
- Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain
Journal of General Internal Medicine
Volume 26, Issue 9 , pp 958-964
- Cover Date
- Print ISSN
- Online ISSN
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- opioid misuse
- chronic pain
- urine drug testing
- Industry Sectors
- Author Affiliations
- 1. Division of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, 111 E. 210th Street, Bronx, NY, 10467, USA
- 2. Yale University School of Medicine, New Haven, CT, USA
- 3. University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- 4. University of Texas Health Science Center and University Health System, San Antonio, TX, USA