Nationally, there has been a surge in the opioid prescription crisis with associated overdose deaths. Vermont is no exception, with increasing opioid overdose related deaths within the last 10 years. A sample (n=111) of opioid addiction patients at the Community Health Centers of Burlington (CHCB) have demonstrated that 25% have their initial use due to provider prescription. New Vermont regulations to decrease opioid prescriptions are inefficient. The goal of this project is to implement a streamlined intervention to improve provider education and comfort regarding new Vermont state opioid prescribing regulations.https://scholarworks.uvm.edu/fmclerk/1326/thumbnail.jp

Leung, Lawrence J

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UVM ScholarWorks

University of VermontScholarWorks @ UVMFamily Medicine Clerkship Student Projects Larner College of Medicine2017Provider Education & Requirements for OpioidPrescriptionsLawrence J. LeungUniversity of VermontFollow this and additional works at: https://scholarworks.uvm.edu/fmclerkPart of the Medical Education Commons, and the Primary Care CommonsThis Book is brought to you for free and open access by the Larner College of Medicine at ScholarWorks @ UVM. It has been accepted for inclusion inFamily Medicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contactdonna.omalley@uvm.edu.Recommended CitationLeung, Lawrence J., "Provider Education & Requirements for Opioid Prescriptions" (2017). Family Medicine Clerkship Student Projects.292.https://scholarworks.uvm.edu/fmclerk/292Community Health Centers of Burlington (FQHC)Lawrence J. LeungRotation Three: 07/2017 – 08/2017Mentor: Heather Stein, MD1 Prescription opioid-related overdose deaths increased dramatically in recent years, parallel with increased opioid prescribing patterns 46 people die daily from prescription painkiller overdose in the US From a sample (n = 111) of opioid addiction patients at the host community (the Community Health Centers of Burlington): Average Age of Initial Opioid Use: 19.66 years Initial use due to Provider Prescriptions: 25% Anecdotal: “Provider’s prescribe a lot of opioids for dental pain because it’s an area where we do not know much about, sympathize with the patient, and dental pain is some of the worst pain…” – CHCB provider2a Opioid Overdose Deaths in Vermont (2002 – 2014): In 2017, new regulations were enacted to control and decrease opioid prescriptions among providers Many providers expressed concerns/difficulties of remembering the new protocols and the online chapter being non-user friendly2b In 2007, total US societal costs of prescription opioid abuse were estimated at $55.7 billion Workplace costs accounted for $25.6 billion (46%) Driven by lost earnings from premature death ($11.2 billion) and reduced compensation/lost employment ($7.9 billion) Health care costs accounted for $25.0 billion (45%) Consisted mainly of excess medical and prescription costs ($23.7 billion) Criminal justice costs accounted for $5.1 billion (9%) Largely consisted of correctional facility ($2.3 billion) and police costs ($1.5 billion) Costs of prescription opioid abuse is a major and growing economic burden on society Provider opioid prescription regulations provide an opportunity to break the costly economic burden3 Dana Poverman – Director of Outpatient and MAT Programs at Howard Center Over 3,000 patients receiving opioid addiction treatment at Hub programs, many more at the Spokes Opioid addiction is associated with crimes in pursuit of more opioids, as well as many other socioeconomic sequelae She believes the best way to improve the opioid crisis is to have sufficiently trained practitioners at all levels – providers, counselors, case managers, etc – to provide empathetic, informed opioid management and care Dr. Beach Conger, MD – Physician at Community Health Centers of Burlington The opioid crisis affects a very specific population – lower socioeconomic class, family history of substance abuse, etc – a population that needs more support and resources He believes the best way to improve the opioid crisis is to get people into treatment and limiting the prescription of opioids4 Literature review on the impact of provider opioid prescriptions on dependence and incorporation of pertinent facts into a concise, informative handout with most up-to-date regulations of opioid prescription requirements Statistical analysis of a de-identified database of a sample of opioid addiction patients at CHCB including: average age of initial opioid use and source of initiation (medical prescription vs nonmedical) Implementation of an educational handout to providers that will provide the significance of opioid prescription cognizance and an easy-to-read list of current Vermont rules for opioid prescriptions Presentation and discussion with providers regarding recent published literature Goal of intervention is decrease provider prescriptions of opioids and subsequently improve health outcomes by decreasing opioid use and addiction5 Response from the physicians, physician assistants and nurse practitioners at the Community Health Centers of Burlington were very positive Providers believe that the handouts made adhering to the new decreased opioid prescribing rules more convenient and feasible A presentation was given about the impact of provider opioid prescriptions, recent published research, and the data about the sample CHCB opioid addiction patients, which was met with good discussion and feedback Handouts were given to providers, placed in the provider computer room, and made available electronically6 Evaluating Effectiveness Quantitative measure of the decrease use of narcotics Qualitative and quantitative measure of increase provider comfort with adhering to the new Vermont regulations Quantitative measure of increase treatment of pain without narcotics Strategies to Improve Effectiveness of Intervention Handouts in convenient locations (provider computer room, clinical pods, patient rooms, etc) Decreasing excessive information makes following requirements user-friendly Limitations Subjectivity of pain Unique situations/cases not described in the handout7 IRB and in-depth statistical analyses of sample CHCB opioid addiction patient database for demographics, characteristics, motivating factors to seek treatment, and motivating factors to maintain addiction Qualitative and quantitative measurements of improved provider comfort with adhering to Vermont opioid regulations IRB and survey CHCB opioid addiction patients the effectiveness of different options (PT, NSAIDS, opioids, etc) for acute pain (ie. How to treat acute pain in chronic opioid patients, suboxone patients, and methadone patients?) IRB and survey CHCB opioid addiction patients whether dental pain was the source of their initial opioid prescription8 1. Birnbaum HG, White AG, Schiller M, Waldman T, Cleveland JM, Roland CL. FORENSIC PAIN MEDICINE SECTION Societal Costs of Prescription Opioid Abuse, Dependence, and Misuse in the United Statesp me_1075 657..667. doi:10.1111/j.1526-4637.2011.01075.x. 2. Chacko J, Greenstein J, Ardolic B, Berwald N. Effect of an emergency department opioid prescription policy on prescribing patterns. Am J Emerg Med. June 2017. doi:10.1016/j.ajem.2017.06.024. 3. Department of Health V. Rule Governing the Prescribing of Opioids for Chronic Pain. http://www.healthvermont.gov/sites/default/files/documents/2016/12/REG_opioids_prescribing_for_chronic_pain.pdf. Accessed August 3, 2017. 4. Guy GP, Zhang K, Bohm MK, et al. Vital Signs: Changes in Opioid Prescribing in the United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017;66(26):697-704. doi:10.15585/mmwr.mm6626a4. 5. Org U, Medcenter /, Fisher P. The heart and science of medicine. The Opiate Crisis in Vermont. http://www.howardcenter.org/assets/userfiles/files/Howard Center PPT 9_8_16.pdf. Accessed August 3, 2017. 6. Sekhri S, Arora NS, Cottrell H, et al. Probability of Opioid Prescription Refilling After Surgery: Does Initial Prescription Dose Matter? Ann Surg. June 2017:1. doi:10.1097/SLA.0000000000002308. 7. Vadivelu N, Kai AM, Kodumudi V, Zhu R, Hines R. Pain Management of Patients with Substance Abuse in the Ambulatory Setting. Curr Pain Headache Rep. 2017;21(2):9. doi:10.1007/s11916-017-0610-3. 8. OPIOID PRESCRIBING RULES. 2017. http://www.healthvermont.gov/sites/default/files/documents/pdf/ADAP_Prescribing Rule Presentation.pdf. Accessed August 3, 2017. 9. Vermont Prescription Monitoring System. 2016. http://legislature.vermont.gov/assets/Documents/2016/WorkGroups/House Human Services/Bills/S.243/Witness Testimony/W~Dr. Harry Chen~Vermont Prescription Monitoring System Report 2015 Progress~4-6-2016.pdf. Accessed August 3, 2017. 10. Certain Prescribing Patterns Lead to Long-term Opioid Use. JAMA. 2017;317(16):1616. doi:10.1001/jama.2017.3766. 11. Chapter 2 – Alcohol and Drug Abuse Subchapter 3 Rule Governing the Prescribing of Opioids for Pain. http://www.healthvermont.gov/sites/default/files/documents/pdf/REG_opioids-prescribing-for-pain.pdf. Accessed August 3, 2017.9 Thank you for agreeing to be interviewed. This project is a requirement for the Family Medicine clerkship. It will be stored on the Dana Library ScholarWorkswebsite. Your name will be attached to your interview and you may be cited directly or indirectly in subsequent unpublished or published work. The interviewer affirms that he/she has explained the nature and purpose of this project. The interviewee affirms that he/she has consented to this interview. Yes __X__ / No _____10

Provider Education & Requirements for Opioid Prescriptions

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Provider Education & Requirements for Opioid Prescriptions

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