Developing an interprofessional team to support patients prescribed long-term high-dose opioid therapy

• Published in: Journal of interprofessional care 2023-03, Vol.37 (2), p.320-324
• Main Authors: Conley, Michael P, Elmes, Abigail T, Roberts, John R, Buck, Lauren, Fantes, Thomas P
• Format: Article
• Language: English
• Subjects: Addictions; Adult; Analgesics, Opioid - adverse effects; Behavior modification; Care plans; Chronic Pain - drug therapy; Co-prescribing; Group decision making; Health education; Health facilities; Humans; Interdisciplinary aspects; Interprofessional Relations; Long term; Morphine; Multidisciplinary teams; Naloxone; Narcotics; Nonsteroidal anti-inflammatory drugs; Opioids; Pain; Pain management; Patient education; Patient-centered care; Patients; Practice Patterns, Physicians; Prescribing; Retrospective Studies; Teams
• ISSN: 1356-1820; 1469-9567
• DOI: 10.1080/13561820.2022.2061929

Despite decreases in US opioid prescribing rates, daily morphine milligram equivalents (MME) prescribed per person remains three times higher than in 1999. An interprofessional team (IPT) was developed to support pain management for patients prescribed long-term high-dose opioids (HDO) in a Federally Qualified Health Center. The IPT utilized a clinical pharmacist, addiction nurse, medical director, and another physician or nurse practitioner to manage adults prescribed long-term HDO, defined as exceeding 50 daily MME. Visits focused on patient education including risks associated with long-term HDO use and effective pain management. The IPT engaged in supportive, individualized care planning for safer, evidence-based pain management, which included, but was not limited to opioid tapers, adjuvant non-opioid pain medications (NOPM), non-pharmacological therapy (NPT), and naloxone co-prescribing. The IPT saw 90% (n = 19) of eligible patients. Excluding outliers, the cohort demonstrated an average 18% ± 24.9 decrease in daily MME. The most common NOPM were acetaminophen, NSAIDs, and pregabalin, and the most common NPT were physical, aquatic, and behavioral therapy. Shared decision-making, collaborative teamwork, and simple patient-centered goals are key to moving patients toward safer, evidence-based therapy.