A New Opioid Guidelines Program Reduces Risk, Number of Prescriptions, and Associations with Fatalities
Aug 9, 2019 12:00 AM
Contact: Dr. Andrew Phillips
An evidence-based opioid guidelines-based program was implemented at the largest worker’s compensation program in Utah. University of Utah researchers at the Rocky Mountain Center for Occupational and Environmental Health found that the program led to significant reductions in opioid use, the length of opioid prescriptions, refill frequency, and the morphine equivalent dose (MED), all of which are key risk factors for long-term opioid use and misuse.
Over 115 people per day die in the United States from overdosing on opioids, and Utah is an astonishing seventh in the nation for drug poisoning deaths. In spite of this, nearly one-third of all Utah adults were prescribed opioids in 2014. Early opioid use is associated with overall higher medical costs, prolonged disability, higher surgery risk, and continued opioid use. Researchers at the Rocky Mountain Center for Occupational and Environmental Health have responded accordingly to this epidemic by implementing educational programs, conducting research, and helping to guide physicians on the safest and most effective ways to prescribe opioids when needed.
Workers Compensation Mutual Fund Insurance Company (WCF) of Utah recently implemented a program with the guidance of the ACOEM Opioid Guidelines Criteria (edited by Dr. Kurt Hegmann, Center Director). Drs. Andrew Phillips, Matthew Thiese, and Kurt Hegmann collaborated with other researchers to examine the efficacy of this program. The WCF protocol required prescribers to follow the guidelines, which required that the injury be severe enough to warrant opioid use, that the morphine equivalent dosage (MED) remained at 50 mg or below, and that all prescriptions be limited to 14 days-supply or less.
This study, published in the Journal of Occupational and Environmental Medicine, found that the program had incredible impact. Acute claims with an opioid prescription were reduced by 50.2%, and the refill rate of opioid prescriptions were reduced by 60.4%. In total, 13, 258 fewer opioid pills were prescribed as a result of this program.
The study also examined the practical implications of implementing a program like this one. Although some providers were initially hesitant to limit their prescriptions, an extensive initiative took place prior to implementation to educate providers and patients of the guidelines and expectations both. Providers and patients could contact registered nurses to discuss prescriptions, with the option to elevate the call to a physician reviewer.
Andrew Phillips, Matthew Thiese, and Kurt Hegmann were joined on this study by Mitche Freeman and Roger Kartchner. Debra Mayo and Paola Stauffer did the development and implementation of the opioid program at WCF Mutual Insurance Fund.