(288) Reducing High Dose Narcotic Therapy for Chronic Non-Cancer Related Pain

Abstract

Following the release of the 2016 CDC Guidelines for Prescribing Opioids for Chronic Pain, there have been intense efforts to reduce the utilization of high dose narcotic therapy for the management of non-cancer related chronic pain. Most prior research on prescription narcotic over-utilization has focused on geographical and community-based statistics, including investigating prescribers with inconsistent prescribing practices and guidelines. To date, there have been few published reports of these efforts in a large health system. In our presentation, we fill this gap by sharing the results of an intervention designed to reduce high dose narcotic therapy for non-cancer related chronic pain in a high-volume hospital-based pain center (census 5,000 patients) embedded within a large health system (11,000 employees). Our multi-modality pain intervention included the development of well-defined prescribing guidelines that enforced a maximum 100 Morphine Equivalent Dose (MED) daily threshold for narcotic therapy in patients with non-cancer related chronic pain. Our team openly communicated the goals of this intervention and related monitoring procedures to pain center patients and staff, as well as care providers across the health system. Outcome measures were collected for 30 months, from January 2016 through June 2018. During this study period, high dose narcotic prescriptions decreased from 20.5% to 0.5%, in established patients with non-cancer related chronic pain undergoing therapy in our pain center. The results suggest our approach – well-defined prescribing guidelines, 100 MED max daily narcotic dosing, and strategic system-wide and patient level communication – should be considered by other health systems as a method to improve adherence with CDC guidelines for opioid prescription.