Opioid Initiative Research Articles

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Corporate Philanthropy ReportVolume 33, Issue 10 p. 2-3 News Briefs News Briefs First published: 19 September 2018 https://doi.org/10.1002/cprt.30228Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract L.L. Bean expands partnership with National Park Foundation. Blue Cross Blue Shield of Arizona launches new opioid addiction initiative. Merck Foundation awards $3 million for Alzheimer's care. Facebook commits $4.5 million for authoritative news. PepsiCo Foundation commits $10 million for recycling initiative. Independence Blue Cross Foundation awards nearly $1.8 million for community health programs. U.S. foundation giving to international causes hits all-time high. Charity Navigator to accept donations in cryptocurrencies. Volume33, Issue10October 2018Pages 2-3 RelatedInformation

Impact of Chronic Opioid Therapy Risk Reduction Initiatives on Opioid Overdose

We assessed the effects of opioid dose and risk reduction initiatives on opioid overdose rates among patients on chronic opioid therapy (COT). Using an interrupted time series design, we compared trends in overdose rates. We compared patients on COT in settings that implemented a COT dose reduction initiative and then a COT risk stratification/monitoring initiative to similar patients on COT from control settings. From 2006 to 2014, 31,142 patients on COT (22,673 intervention, 8,469 control) experienced 311 fatal or nonfatal opioid overdoses. In primary analyses, changes in opioid overdose rates among patients on COT did not differ significantly between intervention and control settings with the implementation of either dose reduction or risk stratification/monitoring. In planned secondary analyses, overdose rates decreased significantly (17% per year) during the dose reduction initiative among patients on COT in intervention settings (relative annual change, 0.83; 95% confidence interval, 0.70–0.99), but not in control settings (0.98. 95% confidence interval, 0.70–1.39). We conclude that overdose rates among patients on COT were not decreased by risk stratification and monitoring initiatives. Results were inconsistent for COT dose reduction, with no significant difference between intervention and control settings (primary hypothesis test), but a significant decrease in overdose rates within the intervention setting during dose reduction (secondary hypothesis test). PerspectiveRisk stratification/monitoring interventions among patients on COT did not decrease opioid overdose rates. The effects of COT dose reduction on opioid overdose rates were inconsistent. Greater decreases in COT dose, a larger control group, or both may have been needed to identify conclusive reductions in opioid overdose rates.

Doctor-Patient Trust Among Chronic Pain Patients on Chronic Opioid Therapy after Opioid Risk Reduction Initiatives: A Survey.

This analysis examined patients' perceptions about trust within the doctor-patient relationship related to managing opioid pain medications. We compared perceptions among chronic opioid therapy (COT) patients who were and were not exposed to opioid risk reduction initiatives. Between 2014 and 2016, we surveyed 1588 adults with chronic pain receiving COT about their trust in their prescribing doctor, their perceptions of their doctor's trust in them, their concerns about opioid prescribing, and their knowledge of opioid safety concerns. The population included adults receiving care in intervention settings that implemented opioid risk reduction initiatives and control settings with similar COT patients that did not. Overall, 82.2% of COT patients said they trusted their doctor's judgment, with more agreement among patients in the control clinics (86.3%; n = 653) than in the intervention clinics (77.9%; n = 935; P = .002). Similarly, slightly more patients in the control clinics believed their physician trusted how they managed their opioid pain medicines (91.1%) compared with the intervention clinics (86.2%; P = .002). The percent who worried that their doctor would stop prescribing opioid pain medicine was 29.3% in intervention clinics and 21.8% in control clinics (P = .007). Although COT patients typically reported favorable perceptions of doctor-patient trust in managing opioid pain medicines, implementation of opioid risk reduction initiatives may have reduced levels of trust for a minority of COT patients. This suggests that it may be possible to implement opioid risk-reduction initiatives while sustaining high levels of doctor-patient trust for most COT patients.

Impact of multidisciplinary chart reviews on opioid dose reduction and monitoring practices

IntroductionThe Veterans Affairs (VA) Eastern Colorado Health Care System implemented an Opioid Safety Initiative (OSI); this included multidisciplinary chart reviews of patients with chronic, non-malignant pain on high-dose opioid therapy to provide safety recommendations to prescribers through the electronic medical record. Our study objective was to evaluate the impact of these documented recommendations. Outcomes included change in total daily opioid dose, concurrent prescribing of opioids and benzodiazepines, adherence to local VA/Veterans Integrated Service Network (VISN) policy, and monitoring practices. MethodsThis retrospective chart review of patients prescribed ≥200 mg of morphine equivalent daily dose (MEDD) collected data from OSI chart reviews conducted between January 1, 2015 and March 31, 2015. Outcomes were assessed during the 12 months following initial review. Primary outcomes included: opioid dose reduction, discontinuation of concurrent benzodiazepines, and adherence to VA/VISN policy, including documentation of signed informed Consent for Long-Term Opioid Therapy for Pain, biannual urine drug screens (UDS), and follow-up every six months with primary opioid prescriber. ResultsOf 147 patients meeting inclusion criteria, 50 patients (34%) reduced opioid dose with the baseline median MEDD decreasing from 315 mg to 278 mg. Of the 48 patients prescribed benzodiazepines and opioids, 10 patients discontinued benzodiazepines (21%). Completion of informed consents increased from 31% to 48%, biannual UDS increased from 44% to 61%, and follow-up with opioid prescriber was unchanged. ConclusionAfter completion of OSI chart reviews, reduction in opioid dose and concurrent prescribing of benzodiazepines was observed. VA/VISN policy and monitoring adherence also showed improvement.

Pharmacists contribute to integrated health systems' approaches to opioid safety.

“I can’t say enough about the role of a pharmacist in this program,” a regional medical director of quality and clinical analysis told an audience on February 15 while describing Kaiser Permanente’s success at promoting safe and appropriate opioid prescribing. Through the Safe and Appropriate Opioid Prescribing program, the 8-region integrated health system in 4 years reduced by nearly 40% the number of patients who were prescribed opioid dosages of 90 or more morphine milligram equivalents (MME) per day, reported Michael H. Kanter, the quality and clinical analysis medical director for Southern California Permanente Medical Group. A 2016 guideline by the Centers for Disease Control and Prevention (CDC) recommends that primary care providers prescribe opioid dosages of less than 90 MME/day for the treatment of chronic pain. Thomas Emmendorfer, deputy chief consultant for pharmacy benefits management services at the Department of Veterans Affairs, said pharmacists’ one-on-one education of prescribers contributed to the success of the federal group’s Opioid Safety Initiative.

Assessment of outcomes following high-dose opioid tapering in a Veterans Healthcare System.

To assess the impact of tapering of chronic high dose opioid therapy in veterans prompted by the implementation of the Opioid Safety Initiative in 2013. IRB and VA Office of Research and Development-approved retrospective, observational chart review. North Florida/South Georgia Veterans Health System Patients: Veterans on high dose opioid therapy (≥300 mg of morphine equivalents per day) for chronic non-cancer pain as of 1/1/2012 with an opioid agreement discontinuation note documented in the medical record were included. Veterans treated for cancer pain or under palliative care were excluded. Descriptive outcomes include rate of opioid discontinuation, average duration of tapering, and rate of relapse. Differences before and after discontinuation assessed include healthcare utilization, monitoring via urine drug screens and state prescription drug monitoring program (PDMP) queries, non-opioid analgesics, benzodiazepines, and non-pharmacologic modalities. Forty-three patients were included. The mean duration of therapy was 7.8 years and 81.4 percent were on methadone prior to tapering. Opioids were tapered to discontinuation in 28 patients (65 percent) with long-term abstinence in 71 percent. The mean duration of tapering was 81 days and the median/mode was 30 days. Statistically significant differences after tapering include decreased PDMP queries, increased non-opioid analgesics, decreased benzodiazepine prescriptions, and increased use of mental health services (p < 0.05). There were zero adverse outcomes identified in those tapered and one death in the group who sought non-VA care for continuation. This study suggests that moderate speed tapering in high-risk veterans on chronic high-dose opioid therapy can be achieved, but caution is warranted in ensuring adequate follow-up and monitoring. Clinical pharmacy services may improve tapering outcomes by providing more frequent follow-up, monitoring via state PDMP queries to identify patients who have relapsed, and dispensing naloxone for increased safety.

Decline in Prescription Opioids Attributable to Decreases in Long-Term Use: A Retrospective Study in the Veterans Health Administration 2010-2016.

Improved understanding of temporal trends in short- and long-term opioid prescribing may inform efforts to curb the opioid epidemic. To characterize the prevalence of short- and long-term opioid prescribing in the Veterans Health Administration (VHA) from 2010 to 2016. Observational cohort study using VHA databases. All patients receiving at least one outpatient prescription through the VHA during calendar years 2010 through 2016. Prevalence of opioid use from 2010 through 2016, stratified by short-term, intermediate-term, and long-term use. Temporal trends in discontinuation among existing long-term users and initiation of new long-term use and the net impact on rates of long-term opioid use. Relative likelihood of transitioning to long-term opioid use contrasted with use patterns in the prior year. The prevalence of opioid prescribing was 20.8% in 2010, peaked at 21.2% in 2012, and declined annually to 16.1% in 2016. Between 2010 and 2016, reductions in long-term opioid prescribing accounted for 83% of the overall decline in opioid prescription fills. Comparing data from 2010-2011 to data from 2015-2016, declining rates in new long-term use accounted for more than 90% of the decreasing prevalence of long-term opioid use in the VHA, whereas increases in cessation among existing long-term users accounted for less than 10%. The relative risk of transitioning to long-term use during 2016 was 6.5 (95% CI: 6.4, 6.7) among short-term users and 35.5 (95% CI: 34.8, 36.3) among intermediate users, relative to patients with no opioid prescriptions filled during 2015. Opioid prescribing trends followed similar trajectories in VHA and non-VHA settings, peaking around 2012 and subsequently declining. However, changes in long-term opioid prescribing accounted for most of the decline in the VHA. Recent VA opioid initiatives may be preventing patients from initiating long-term use. This may offer valuable lessons generalizable to other healthcare systems.

Impact of Opioid Dose Reduction and Risk Mitigation Initiatives on Chronic Opioid Therapy Patients at Higher Risk for Opioid-Related Adverse Outcomes

We aimed to determine if opioid risk reduction initiatives including dose reduction and risk mitigation strategies for chronic noncancer pain patients receiving chronic opioid therapy (COT) had a differential impact on average daily opioid doses of COT patients at higher risk for opioid-related adverse outcomes compared with lower-risk patients. Interrupted time series. Group Health Cooperative (GH), a health care delivery system and insurance within Washington State, between 2006 and 2014. GH enrollees on COT defined as receiving a supply of 70 or more days of opioids within 90 days using electronic pharmacy data for filled prescriptions. We compared the average daily morphine equivalent doses (MED) of COT patients with and without each of the following higher-risk characteristics: mental disorders, substance use disorders, sedative use, and male gender. In all four pairwise comparisons, the higher-risk subgroup had a higher average daily MED than the lower-risk subgroup across the study period. Adjusted for covariates, modest differences in the annual rate of reduction in average daily MED were noted between higher- and lower-risk subgroups in three pairwise comparisons: those with mental disorders vs without (-8.2 mg/y vs -5.2 mg/y, P = 0.005), with sedative use vs without (-9.2 mg/y vs -5.8 mg/y, P = 0.004); mg), in men vs women (-8.8 mg/y vs -5.9 mg/y, P = 0.01). Using clinical policy initiatives in a health care system, dose reductions were achieved among COT patients at higher risk for opioid-related adverse outcomes that were at least as large as those among lower-risk patients.

Prevalence of prescription opioid use disorder among chronic opioid therapy patients after health plan opioid dose and risk reduction initiatives

BackgroundNo studies have assessed the comparative effectiveness of guideline-recommended interventions to reduce risk of prescription opioid use disorder among chronic opioid therapy (COT) patients. We compared the prevalence of prescription opioid use disorder among COT patients from intervention clinics that had implemented opioid dose and risk reduction initiatives for more than 4 years relative to control clinics that had not. MethodsAfter a healthcare system in Washington State implemented interventions to reduce opioid dose and risks, we surveyed 1588 adult primary care COT patients to compare the prevalence of prescription opioid use disorder among COT patients from the intervention and control clinics. Intervention clinics managed COT patients at lower COT doses and with more consistent use of risk reduction practices. Control clinics cared for similar COT patients but prescribed higher opioid doses and used COT risk reduction practices inconsistently. Prescription opioid use disorder was assessed with the Psychiatric Research Interview for Substance and Mental Disorders. ResultsThe prevalence of prescription opioid use disorder was 21.5% (95% CI=18.9% to 24.4%) among COT patients in the intervention clinics and 23.9% (95% CI=20.5% to 27.6%) among COT patients in the control clinics. The adjusted relative risk of prescription opioid use disorder was 1.08 (95% CI=0.89, 1.32) among the control clinic patients relative to the intervention clinic patients. ConclusionsLong-term implementation of opioid dose and risk reduction initiatives was not associated with lower rates of prescription opioid use disorder among prevalent COT patients. Extreme caution should be exercised by clinicians considering COT for patients with chronic non-cancer pain until benefits of this treatment and attendant risks are clarified.

NIH undertakes public‐private opioid initiative

The National Institute on Drug Abuse (NIDA), under the leadership of Francis S. Collins, M.D., Ph.D., director of the National Institute of Health (NIH), is moving forward to establish a public‐private partnership addressing three major areas: (1) new and innovative medications to treat opioid use disorders and for overdose prevention and reversal; (2) safe, effective and nonaddictive strategies to manage chronic pain; and (3) neurobiology of chronic pain.

NIH undertakes public‐private opioid initiative

NIH undertakes public‐private opioid initiative

Indian Health Service pharmacists engaged in opioid safety initiatives and expanding access to naloxone

ObjectiveTo develop effective pharmacy-based interventions to mitigate harm from opioid use disorders. Programs include responsible opioid prescribing, expanded access to medication-assisted treatment (MAT), naloxone, and community interventions. SettingClinical pharmacists practicing at Indian Health Service (IHS) locations in the Southwest, Midwest, and Great Lakes regions. These pharmacists serve culturally diverse American Indian populations throughout the United States and interface with tribal and federal programs to impact the opioid epidemic in Indian Country. Practice descriptionPharmacists have reduced barriers to care by expanding clinical practices to include novel approaches in pain management clinics and MAT programs. Practice innovationAs part of a multidisciplinary team, IHS pharmacists provide comprehensive patient care while focusing on the prevention of opioid dependence and opioid overdose death. EvaluationPharmacists have also expanded professional competencies to include coprescribing naloxone and training first responders on naloxone use. ResultsPharmacists within IHS have proactively completed advanced training on responsible opioid prescribing, augmented services to increase access to MAT for American Indians and Alaska Natives, and increased access to naloxone for opioid overdose reversal. Pharmacists have also developed a comprehensive training program and program measurement tools for law enforcement officers serving in tribal communities. These materials were used to train 350 officers in 6 districts and conduct a mass naloxone dispensing initiative across Indian Country. Pharmacists have consequently developed successful community coalitions that are focused on saving lives. ConclusionsPharmacist involvement in key initiatives including responsible opioid prescribing, expanded access to MAT, and expanded access to naloxone for trained first responders, coupled with an emphasis on enhanced education, illustrates pharmacists' impact with the opioid epidemic.

Development and applications of the Veterans Health Administration’s Stratification Tool for Opioid Risk Mitigation (STORM) to improve opioid safety and prevent overdose and suicide.

Concerns about opioid-related adverse events, including overdose, prompted the Veterans Health Administration (VHA) to launch an Opioid Safety Initiative and Overdose Education and Naloxone Distribution program. To mitigate risks associated with opioid prescribing, a holistic approach that takes into consideration both risk factors (e.g., dose, substance use disorders) and risk mitigation interventions (e.g., urine drug screening, psychosocial treatment) is needed. This article describes the Stratification Tool for Opioid Risk Mitigation (STORM), a tool developed in VHA that reflects this holistic approach and facilitates patient identification and monitoring. STORM prioritizes patients for review and intervention according to their modeled risk for overdose/suicide-related events and displays risk factors and risk mitigation interventions obtained from VHA electronic medical record (EMR)-data extracts. Patients' estimated risk is based on a predictive risk model developed using fiscal year 2010 (FY2010: 10/1/2009-9/30/2010) EMR-data extracts and mortality data among 1,135,601 VHA patients prescribed opioid analgesics to predict risk for an overdose/suicide-related event in FY2011 (2.1% experienced an event). Cross-validation was used to validate the model, with receiver operating characteristic curves for the training and test data sets performing well (>.80 area under the curve). The predictive risk model distinguished patients based on risk for overdose/suicide-related adverse events, allowing for identification of high-risk patients and enrichment of target populations of patients with greater safety concerns for proactive monitoring and application of risk mitigation interventions. Results suggest that clinical informatics can leverage EMR-extracted data to identify patients at-risk for overdose/suicide-related events and provide clinicians with actionable information to mitigate risk. (PsycINFO Database Record

Impact of the opioid safety initiative on opioid prescribing practices in the veterans healthcare administration

Impact of the opioid safety initiative on opioid prescribing practices in the veterans healthcare administration

Impact of the Opioid Safety Initiative on opioid-related prescribing in veterans.

The Veterans Health Administration (VHA) designed the Opioid Safety Initiative (OSI) to help decrease opioid prescribing practices associated with adverse outcomes. Key components included disseminating a dashboard tool that aggregates electronic medical record data to audit real-time opioid-related prescribing and identifying a clinical leader at each facility to implement the tool and promote safer prescribing. This study examines changes associated with OSI implementation in October 2013 among all adult VHA patients who filled outpatient opioid prescriptions. Interrupted time series analyses controlled for baseline trends and examined data from October 2012 to September 2014 to determine the changes after OSI implementation in prescribing of high-dosage opioid regimens (total daily dosages >100 morphine equivalents [MEQ] and >200 MEQ) and concurrent benzodiazepines. Across VHA facilities nationwide, there was a decreasing trend in high-dosage opioid prescribing with 55,722 patients receiving daily opioid dosages >100 MEQ in October 2012, which decreased to 46,780 in September 2014 (16% reduction). The OSI was associated with an additional decrease, compared to pre-OSI trends, of 331 patients per month (95% confidence interval [CI] -378 to -284) receiving opioids >100 MEQ, a decrease of 164 patients per month (95% CI -186 to -142) receiving opioids >200 MEQ, and a decrease of 781 patients per month (95% CI -969 to -593) receiving concurrent benzodiazepines. Implementation of a national health care system-wide initiative was associated with reductions in outpatient prescribing of risky opioid regimens. These findings provide evidence for the potential utility of large-scale interventions to promote safer opioid prescribing.

Impact of an opioid risk reduction initiative on motor vehicle crash risk among chronic opioid therapy patients.

Although prescription opioids have been associated with higher motor vehicle crash (MVC) risk, it is unknown whether health system initiatives to better manage chronic opioid therapy (COT) can reduce MVC risk at the population level. We conducted an interrupted time series population-level cohort study at Group Health (GH), between January 2006 and September 2014, comparing MVC risk among COT patients who were GH members receiving care in either group practice or contracted care settings. Group practice COT risk reduction initiatives were implemented in two phases: (1) altered prescribing expectations and (2) multifaceted initiatives. These initiatives did not exist in the contracted care network. We compared the adjusted quarterly rate of MVC between group practice and contracted care patients over time using a modified Poisson regression model for a binary outcome. A total of 32 691 COT patients (27.4% from contracted care) met eligibility criteria and experienced a total of 1956 MVCs during study follow-up (mean, 8.1 quarters per person), of which 810 were serious injury crashes. Crash rates were not significantly different between the patient groups within any of the time periods. Analyses stratified by concurrent prescription of a sedative hypnotic or benzodiazepine found no significant difference between the group practice and contracted care patients. There was a modest elevation of MVC risk for high-dose patients relative to former COT patients who stopped receiving opioids. The risk of MVC was not mitigated in a large cohort of COT patients exposed to a health plan policy initiative that substantially lowered mean opioid dose. Copyright © 2016 John Wiley & Sons, Ltd.

HHS Takes Actions to Expand Treatment, Research In Opioid Crisis

Back to table of contents Previous article Next article Government NewsFull AccessHHS Takes Actions to Expand Treatment, Research In Opioid CrisisAaron LevinAaron LevinSearch for more papers by this authorPublished Online:28 Jul 2016https://doi.org/10.1176/appi.pn.2016.8a18AbstractThe federal government hopes to expand access to addiction treatment, improve prescribing practices, and reduce administrative burdens.The Department of Health and Human Services (HHS) in July took steps to combat the opioid epidemic by issuing a rule expanding access to buprenorphine treatment and proposing elimination of a possible financial incentive to overprescribe opioids.In other actions, HHS will require Indian Health Service practitioners to check state Prescription Drug Monitoring Program (PDMP) databases before prescribing opioids. The agency also announced the start of more than a dozen new research studies on pain treatment and opioid misuse.The department’s new rule on buprenorphine treatment increases from 100 to 275 the number of patients a specially trained physician can treat. Addiction specialists and those who practice in a qualified health setting will be eligible for the higher patient limit after they have held a Drug Enforcement Administration waiver for the 100-patient limit for at least a year.Improving access to addiction treatment will require more prescribers to treat more patients, says Frances Levin, M.D., chair of APA’s Council on Addiction Psychiatry.“These are reasonable steps forward, but the real question is how to get more trained prescribers to take more patients,” said Frances Levin, M.D., chair of APA’s Council on Addiction Psychiatry and a professor and chief of the Division of Substance Abuse at Columbia University and the New York State Psychiatric Institute.Increasing the waiver limit is not enough, she said in an interview. Many physicians, possibly a majority, now holding waivers do not treat the maximum number of patients allowed, and some do not treat any.Even when trained, many are not comfortable using buprenorphine or working with patients with drug use disorders, she said. Other problems like insurance barriers, the lack of staff resources, or the inability to provide or refer to psychotherapy hamper broader use of buprenorphine.Drug monitoring programs, which require physicians to check a database to see what other drugs a patient may be taking, have been a state responsibility and have proven generally useful, said Levin.“I find it extremely helpful not just for monitoring use of opioids but also for seeing what drugs have been prescribed by other doctors that the patient hasn’t told me about,” she said.In 2014, the most recent year for which complete statistics are available, 47,055 people died of drug overdoses in the United States, of which 28,647 (61 percent) involved opioids. HHS announced its opioid initiative in March. The program focused on improving prescribing practice, expanding use and access to medication-assisted treatment, and increasing the use of naloxone to reverse overdoses (Psychiatric News, May 6).President Obama has requested $1.1 billion over the next two fiscal years to finance those goals.The agency also set forth steps to continue its research plan to study more about the epidemiology of opioid use, advance knowledge of pain and addiction, and find new treatments.HHS will also eliminate use of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey questions on pain as a criterion for Medicare payment. To keep patient pain management satisfaction scores high, some clinicians have felt pressure to overprescribe opioids. Now, hospitals will still ask patients about pain management, but the answers will not affect payments. APA played an important role in shaping the final rule on limits for patients treated with buprenorphine by one physician.“We welcome the final rule raising the cap on buprenorphine patients because it balances the needs for access to quality care and safety,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “APA had provided feedback to SAMHSA, and we are encouraged that the agency followed the spirit of our recommendations.”The American Academy of Addiction Medicine and the American Osteopathic Academy of Addiction Medicine joined with APA in offering comments to HHS about the buprenorphine limit. ■More information on the Department of Health and Human Services’ opioid initiative can be accessed here. ISSUES NewArchived

Opioid Safety Initiative of the Veteran's Health Administration

The Veteran's Health Administration has been a leader in pain management for more than two decades. This presentation will review the pain management strategy in the VHA from the 1990s through the present. This includes what we were initially taught about pain management and what is currently being taught along with supporting information. It will include a review of key CDC reports concerning opioid use. It will include research results supporting what is being taught. It will include what prescribers are currently being taught about opioid prescribing.

Opioid Overdose Prevention Initiatives on the College Campus: Critical Partnerships between Academe and Community Experts

Attention has recently turned to the epidemic Opioid Overdose deaths in our country. From the President and political platforms to community groups to legislators, the crisis is being illuminated and changes are being effected. Presently, all but five states (AZ, KS, MO, MT, WY) have passed legislation designed to improve layperson naloxone access [1]. Naloxone hydrochloride is a generic, non-narcotic opioid antagonist that blocks the brain cell receptors activated by opioids. It is a fast-acting drug that, when administered during an overdose blocks the effects of opioids on the brain and restores breathing within two to three minutes of administration. It is not psychoactive, has no potential for abuse, and side effects are rare [2]. Naloxone makes opioid overdose prevention effective with the injectable or inhalable response [3]. On college campuses, overdose is no longer “someone else’s problem.” A 19 y/o University of Texas Freshman with a 4.0 GPA died of opiate overdose during break. Soon after, overdose took the life of a male student in an off-campus dorm. The numbers are growing and impacting this population profoundly. The lack of knowledge, stigma, and resistance on the part of physicians, pharmacists and administrators are slowing the necessary progress of solutions and this commentary serves as a call to action, an evidence-base, and encouragement to the relevant professions to embrace the new policies, resources, and lifesaving medical advances such as Naloxone.

The Impact of Opioid Risk Reduction Initiatives on High-Dose Opioid Prescribing for Patients on Chronic Opioid Therapy

Avoiding high opioid doses may reduce chronic opioid therapy (COT) risks, but the feasibility of reducing opioid doses in community practice is unknown. Washington State and a health plan's group practice implemented initiatives to reduce high-dose COT prescribing. The group practice physicians were exposed to both initiatives, whereas contracted physicians were exposed only to statewide changes. Using interrupted time series analyses, we assessed whether these initiatives reduced opioid doses among COT patients in group practice (n = 16,653) and contracted care settings (n = 5,552). From 2006 to June 2014, the percentage of COT patients receiving ≥120 mg morphine equivalent dose declined from 16.8% to 6.3% in the group practice versus 20.6 to 13.6% among COT patients of contracted physicians. The proportion receiving excess opioid days supplied declined from 24.0 to 10.4% among group practice COT patients and from 20.1 to 14.7% among COT patients of contracted physicians. Reductions in prescribing of high opioid dose and excess opioid days supplied followed state and health plan initiatives to change opioid prescribing. Reductions were substantially greater in the group practice setting that implemented additional initiatives to alter shared physician expectations regarding appropriate COT prescribing, compared with the contracted physicians' patients. PerspectiveWashington State and a health plan's group practice implemented initiatives to reduce high-dose COT prescribing. Group practice physicians were exposed to both initiatives, whereas the health plan's contracted physicians were exposed to only the statewide changes. Reductions in prescribing of high opioid dose, average daily dose, and excess opioid days supplied followed state and health plan initiatives to change opioid prescribing. Reductions were substantially greater in the group practice setting that implemented additional initiatives to alter shared physician expectations regarding appropriate COT prescribing, compared with the contracted physicians' patients.