In recent years, the medical community has faced the daunting challenge of addressing the opioid crisis, which has led to significant changes in prescribing practices. A new study in JAMA Network Open, “Strategies to Deimplement Opioid Prescribing in Primary Care: A Cluster Randomized Clinical Trial,” shows promise for various strategies aimed at reducing opioid prescriptions at the clinic and provider level.
Andrew Quanbeck, PhD
The research team includes faculty and staff from the UW Department of Family Medicine and Community Health: Andrew Quanbeck, PhD, Xiang Li, MS, Jillian Landeck, MD, Alice Pulvermacher, MS, Randall Brown, MD, PhD, and Nora Jacobson, PhD, from the UW Institute for Clinical and Translational Research and the School of Nursing.
The study looks at different ways to reduce the daily dose of opioids (measured in morphine milligram equivalents or MME) that patients take. The most intensive approach, which includes education, monitoring, feedback, practice facilitation, and patient-centered care, led to a small but meaningful reduction in the daily opioid dose compared to the least intensive approach, which only includes education, monitoring, and feedback. Specifically, the reduction was 2.4 mg per day, which is about a 6% decrease from the starting average dose of 38.7 mg per day.
Dr. Andrew Quanbeck, the study’s principal investigator, suggests one interpretation of the study is that doctors, given many guidelines and limited time, tend to focus less on treatment agreements and urine drug tests. Instead, they prioritize patient-centered screenings for pain, enjoyment, and quality of life. This shift shows how medical opinions on the efficacy of certain guidelines have evolved.
“The 2022 CDC guidelines recommendation to start with a low dosage and go slow with new prescriptions seems to be the most solid recommendation that we can all agree is worth doing, and that is what we saw in the most intensive group in this study,” adds Quanbeck.
As for next steps, Quanbeck’s team is focusing efforts on studying implementation of evidence-based integrative medicine approaches for chronic pain management in lieu of opioids in partnership with the Osher Center for Integrative Health at UW.
“This study did not offer any patient-facing interventions for chronic pain as it was aimed at reducing opioid use, but there is still a gap to be filled,” says Quanbeck. “We are collectively taking opioids away, but chronic pain isn’t going anywhere.”
Published: November 2024