Compliance with Opioid Treatment Guidelines for Chronic Non‐Cancer Pain (CNCP) in Primary Care at a Veterans Affairs Medical Center (VAMC)

• Published in: Pain medicine (Malden, Mass.) Mass.), 2013-10, Vol.14 (10), p.1548-1556
• Main Authors: Sekhon, Ripple, Aminjavahery, Noushin, Davis, Charles N., Roswarski, Mary Jayne, Robinette, Camille
• Format: Article
• Language: English
• Subjects: Aberrant; Adult; Aged; Aged, 80 and over; Analgesics, Opioid - therapeutic use; Chronic Pain - drug therapy; Compliance; Drug dosages; Female; Guideline Adherence - statistics & numerical data; Hospitals, Veterans - statistics & numerical data; Humans; Male; Middle Aged; Non‐Cancer; Older people; Opioid; Pain; Practice Guidelines as Topic; Practice Patterns, Physicians' - statistics & numerical data; Prescribing; Primary Care; Primary Health Care - statistics & numerical data; Retrospective Studies; United States; Young Adult
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1111/pme.12164

Objective The primary objective of this study was to measure prescribing compliance with the Veterans Affairs/Department of Defense treatment guidelines for chronic non‐cancer pain (CNCP) in the primary care setting. We also determined the proportion of subjects who demonstrated aberrant drug‐related behaviors (ADRBs) and the patient characteristics associated with them. Design This is a retrospective chart review. Setting Primary care setting in Veterans Affairs Medical Center. Subjects All patients with CNCP between the ages of 18 and 87 years who received opioid prescriptions for 3 or more consecutive months during a 1‐year period (July 2009 to August 2010) were eligible for inclusion. A random sample of 800 patients was selected using pharmacy prescription database. Chi‐square test was utilized to analyze associations between ADRB and patient characteristics. Results About half the patients in our sample had a signed opioid pain care agreement (OPCA), and at least one urine drug test (UDT) was obtained. UDT was positive for an illicit drug/unreported opioid in 19.5% of the patients, and negative for the prescribed drug in 25.2% of the sample. About 10% of the sample population had morphine equivalent dose equal to or greater than 200 mg/day. ADRBs were identified in 22.9% of the patients. Younger age, psychiatric comorbidities, history of substance abuse, and high opioid dose were associated with high risk of ADRB, but the presence of OPCA lowered the risk of ADRB. Conclusion This article studied the prescribing practices of opioids in a primary care setting and can be used to enhance provider education regarding chronic pain guidelines.