Six Principles for Opioid Prescribing: MGMA Report

When it comes to reducing the risk of opioid abuse and the over-prescribing of opioid medications, medical practices should think in terms of communication, technology and referral management, a new report from the Medical Group Management Association (MGMA) advises.

Titled Combating the Opioid Epidemic: Effective Policies and Communication Strategies – An MGMA Research & Analysis report, the publication draws on survey data, in-depth interviews with 43 healthcare leaders and case studies in presenting a set of policy principles designed to help medical practitioners and organizations play their part in curbing this major public health crisis. Though current data from the Centers for Disease Control and Prevention indicate a sharp rise in overdose deaths due to synthetic opioids such as illicitly manufactured fentanyl, about 40 percent of overdose deaths still involve a prescription opioid, such as methadone, oxycodone or hydrocodone.

MGMA President and CEO Halee Fischer-Wright, MD, said the report is designed to arm practice leaders to be "even more effective in fighting this epidemic at one of the most critical junctures: point of care."

Based on an analysis of research, MGMA concludes that an effective opioid prescribing policy should be grounded in the following three elements:

  1. Communication: Clear and open lines of communication between all parties involved in the prescription process (patients, clinicians, staff and pharmacists). Effective communication should also encompass ensuring that all parties understand the proper use of opioids and red flags for potential misuse and abuse.
  2. Technology: An effective opioid prescribing policy should leverage technology to track prescriptions. This includes use of prescription drug monitoring programs (PDMPs) to identify patients who have received opioid prescriptions from other providers and the use of electronic prescriptions for controlled substances to help prescribers track prescriptions and prevent fraudulent prescriptions from being filled.
  3. Referral management: Providers must have a good understanding of the capabilities and limitations of the specialists to whom they refer patients. This understanding increases the likelihood that patients will receive appropriate and good quality care and reduces the risk of providers relying too heavily on opioid prescriptions to manage pain rather than treat the underlying cause.

The following six principles should guide all medical practices in developing an opioid prescribing policy, according to MGMA:

  1. Don't make opioid therapy routine: Opioid therapy should not be a first-line therapy for chronic pain. When expected benefits outweigh risks, opioid therapy can be used, but in combination with preferred nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate.
  2. Know the care goals: Treatment plans should include a plan for discontinuing opioid therapy as patients near their goals.
  3. Continuing education and evaluation: Patients should always be educated about the potential risks associated with opioid therapy, including the risk of addiction and misuse. MGMA recommends an evaluation of the benefits and harms of opioid use one to four weeks after the start of therapy or after any dosage increase.
  4. Use proper dosage/duration: Immediate-release opioids at the lowest effective dosage are preferred for starting therapy, prescribed in a quantity no greater than what is required for the duration of pain that is severe enough to require opioids.
  5. Know the risks: Clinicians should use state PDMP data for patients before starting an opioid therapy and periodically thereafter, whether at every prescription or as infrequently as every three months. Additionally, urine drug testing of patients should precede the start of opioid therapy, with subsequent testing (at least annually) after beginning therapy.
  6. Be ready to handle misuse: Practice clinicians who encounter patients with opioid use disorder should be ready to offer or arrange treatment, which frequently includes buprenorphine or methadone along with therapy for behaviors tied to substance misuse.

"The regulatory and reimbursement landscape surrounding opioid prescriptions is poised for further change, and delivering high-quality care remains an immediate goal for the nation's healthcare providers," the report concludes. "Practice leaders who lead the conversation on implementing best-practice prescription policies in conjunction with provider and staff engagement will position their organizations to offer the best care delivery. This tactic, paired with effective patient education and communication strategies, offers a strong approach to preventing and combating opioid misuse and addiction."

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Sunday, 17 February 2019

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