Safe Opioid Prescribing Project

Abstract

The 2017 Department of Veteran Affairs and Department of Defense (VA/DoD) Opioid Therapy for Chronic Pain Clinical Practice Guidelines (CPGs), represented a paradigm shift in opioid prescribing. The guidelines highlighted the risk of adverse effects, including addiction, overdose, and effects on almost every organ system of the body. The CPGs discouraged against initiation of opioids for chronic use, and advised against exceeding 90 morphine equivalent daily dose (MEDD) for those already on chronic opioid therapy. Research question: will providers reduce their opioid prescribing, if they know that their opioid prescribing exceeds the institutions norms? Quantitative data analysis. The Defense Health Agency (DHA) tracks all military treatment facility providers on a report called the Controlled Substance Prescriber Profile (CSPP) report. A pharmacist used the quarterly CSPP report to identify the top 20 prescribers from Walter Reed, by MED. Letters signed by the Chief of Pharmacy were sent to the prescribers informing them of their MED, along with the institution's average MED. The intervention was repeated quarterly over 2 years. A paired t-test was performed on the quarterly MPA results to see if any changes occurred after the intervention. The paired t-test between 2017 and 2018 resulted in a tStat of 0.897, a p value of 0.217, and a tCritical of 2.353, suggesting there was no difference between the two populations. Comparatively, 2017 compared to 2019 resulted in in a tStat of 4.684, a p value of 0.009, and a tCritical of 2.353; the results of 2017 verses 2019 demonstrate a significant difference. When providers are aware that their prescribing exceeds the institution's norm, they realign their prescribing habits to that of their institution. This study could also be replicated through the prescription drug monitoring program for a group practice, or within a health system.