A health plan initiative designed to change physicians’ expectations involving opioid prescriptions has shown positive results in lowering dosage levels of patients receiving chronic opioid treatment (COT). The research, published in The Journal of Pain, involved an analysis of a new initiative by Washington State and an additional complementary health plan group practice initiative.

Washington state enacted guidelines in 2010, recommending caution in prescribing daily morphine equivalent  dosing of ≥120mg. This was mandated for long-term opioid prescribing for patients with chronic non-cancer pain but did not include hospice or palliative care, and management of acute pain post-injury or surgery. Researchers from the Group Health Research Institute compared rates of high-dose opioid prescribing in COT patients statewide and within a health plan. Trends in the plan’s group practice were compared to trends among the health plan’s contracted physicians who only followed the state guidelines. 

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A total of 16,653 COT patients were part of a group that followed both, the states guidelines, and the health plan’s group practice initiative, while 5,552 followed the state-only guidelines. Data was analyzed from 2006–2014. During the study period, the number of COT patients in the group practice receiving ≥120mg a day declined from 16.8% to 6.3%. The group with contract care settings, exposed to the state-only guidelines, showed a lower decrease of 20.6% to 13.6%.

A greater decline occurred in the number of COT patients receiving excess prescription days. The group practice subset decreased by 14% in excess prescription days from 24% to 10%. A decrease of just 5.4% was registered in the contract care subset from 20.1% to 14.7%.

Overdoses are increasingly related to high dose prescriptions of opioids. The recent rescheduling of hydrocodone combination analgesics from Schedule III to II is the most recent strategy aimed at curtailing opioid-related abuses. This resulted in a drop of 22% in prescriptions. The results of this study demonstrate that physician initiatives can also help reduce the prevalence of higher dosing. 

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