Reducing the Pain Behind Opioid Prescribing in Primary Care

Objective. To describe the efficacy of a comprehensive approach aimed at reducing opioid prescribing in an internal medicine resident clinic. Design. Retrospective observational study. Setting. Internal medicine primary care resident clinic at a large urban academic medical center. Subjects. All patients receiving opioid prescriptions from the primary care clinic. Methods. We reviewed pharmacy dispensing data for two hospital-affiliated pharmacies for resident primary care patients filling opioid prescriptions between July 2016 and July 2018. We instituted a comprehensive set of interventions that included resident education, limiting supervision of encounters for long-term opioid therapy (LTOT) to a fixed set of faculty champions, and providing alternate modalities for pain control. We calculated the change in number of opioid prescriptions dispensed, number of patients receiving opioid prescriptions, morphine milligram equivalents (MMEs) dispensed, and average per-patient daily MMEs dispensed. Results. We observed an average monthly reduction of 2.44% (P< 0.001) in the number of prescriptions dispensed and a 1.83% (P< 0.001) monthly reduction in the number of patients receiving prescriptions. Over the two-year period, there was a 74.3% reduction in total MMEs prescribed and a 66.5% reduction in the average MMEs prescribed per patient. Conclusions. Our findings demonstrate a significant reduction in opioid prescribing after implementation of a comprehensive initiative. Although our study was observational in nature, we witnessed a nearly threefold decrease in opioid prescribing compared with national trends. Our results offer important insights for other primary care resident clinics hoping to engender safe prescribing practices and curb high-dose opioid prescribing.