Physicians Often Don't Follow Guidelines for Opioid Therapy

October 09, 2012

October 9, 2012 — A new study confirms what government regulators and medical experts say about how well physicians are managing patients on opioid analgesics — not so well.

Roughly 1 in 12 injured workers prescribed opioid analgesics were still taking them 7 to 12 months later, and usually without receiving recommended follow-up services such as urine tests and psychological evaluation, according to a new 21-state study published last week by the Workers Compensation Research Institute (WCRI).

Extended use of opioid analgesics rings alarm bells for WCRI because it has a "greater potential for overuse, abuse and diversion, and also puts injured workers at a higher risk of disability, and work loss, and even death from prescription drug overdose," write study authors Dongchun Wang, Dean Hashimoto, MD, and Kathryn Mueller, MD.

The study, titled "Longer-Term Use of Opioids," looked at almost 300,000 workers' compensation claims arising from injuries incurred from October 1, 2006, to September 30, 2009, and more than 1.1 million associated prescriptions for pain medications that were filled up to March 31, 2011. These claims and prescriptions were divided into 3 time frames: 2007-2009, 2008-2010, and 2009-2011.

Louisiana posted the highest percentage — 17% — of injured workers who were longer-term opioid users during the 2009-2011 period. At the low end was Arizona, at 3%. The median for the 21 states in the study was 8%, up from 7% in 2007-2009.

Among injured workers who were longer-term users of pain medications in 2009-2011, 24% had at least 1 urine test, for an increase of 10 percentage points during 2007-2009. The use of drug testing, though, "was still low," according to the report.

In addition, a median 7% of these injured workers received psychological evaluations and 4% received psychological treatments in 2009-2011 — rates that had changed little since 2007-2009.

One bright note was routine reliance on physical therapy: The 21-state median for physical therapy was 90%.

WCRI drew on treatment guidelines from such groups as the American Pain Society and the American Academy of Pain Medicine to come up with its key measures of pain medicine management.

Drumbeat for More Physician Education on Pain Medications

WCRI's findings — that physicians usually do not comply with pain medicine guidelines — probably will come as no surprise to the US Food and Drug Administration (FDA). In July, the FDA approved a risk evaluation and mitigation strategy (REMS) for extended-release and long-acting opioids prescribed for moderate to severe chronic pain that calls for continuing medical education (CME) programs on the proper use of these drugs.

Medical education providers under FDA oversight will develop the elective REMS courses, and drug manufacturers will fund them. The goal is to instruct clinicians on how to weigh the risks and benefits of opioid therapy and recognize the signs of opioid misuse, abuse, and addiction.

In the same vein, the Office of National Drug Control Policy and the National Institute on Drug Abuse (NIDA) rolled out 2 online learning modules on opioid analgesics for clinicians last month. The 2 modules, titled "Safe Prescribing for Pain" and "Managing Pain Patients Who Abuse Prescription Drugs," are available on the NIDA and Medscape Education Web sites.

Each module is worth 1.25 CME credits.