Opioid prescribing in the U.S. Military Health System, 2014 to 2018: fewer prescriptions, fewer pills, and shorter treatment duration

Goldman, Ashton H.; Johnson, Daniel D.; Griffis, Clare; Land, Vaughn; Balazs, George C.

doi:10.1097/j.pain.0000000000002313

Cited by 9 publications

(3 citation statements)

References 26 publications

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“…However, the number of opioid prescriptions dispensed and the number of patients meeting the criteria for risk indicators decreased across time. These results are consistent with findings indicating the overall rates of opioid prescribing have been decreasing in the Military Health System, 8 including high-dose opioid prescribing. Naloxone prescribing policies and programs may be effective at various levels of intervention.…”

Section: Discussionsupporting

confidence: 91%

Naloxone prescribing practices in the Military Health System before and after policy implementation

Pakieser

Peters

Tilley

et al. 2021

PR9

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Introduction: Despite public health campaigns, policies, and educational programs, naloxone prescription rates among people receiving opioids remains low. In June 2018, the U.S. Military Health System (MHS) released 2 policies to improve naloxone prescribing.Objectives: The objective of this study was to examine whether the policies resulted in increased naloxone coprescription rates for patients who met the criteria for 1 or more risk indicators (eg, long-term opioid therapy, benzodiazepine coprescription, morphine equivalent daily dose $50 mg, and elevated overdose risk score) at the time of opioid dispense. Methods: Prescription and risk indicator data from January 2017 to February 2021 were extracted from the MHS Data Repository. Naloxone coprescription rates from January 2017 to September 2018 were used to forecast prescribing rates from October 2018 to February 2021 overall and across risk indicators. Forecasted rates were compared with actual rates using Bayesian time series analyses. Results: The probability of receiving a naloxone coprescription was higher for patients whose opioid prescriber and pharmacy were both within military treatment facilities vs both within the purchased-care network. Bayesian time series results indicated that the number of patients who met the criteria for any risk indicator decreased throughout the study period. Naloxone prescribing rates increased across the study period from ,1% to 20% and did not significantly differ from the forecasted rates across any and each risk indicator (adjusted P values all .0.05). Conclusion: Future analyses are needed to better understand naloxone prescribing practices and the impact of improvements to electronic health records, decision support tools, and policies.

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Section: Discussionsupporting

confidence: 91%

Naloxone prescribing practices in the Military Health System before and after policy implementation

Pakieser

Peters

Tilley

et al. 2021

PR9

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“…While prescription of opioids has fallen in US private and public healthcare sectors, pharmacists must remain vigilant as they play a pivotal role in preventing opioid overdoses being responsible for controlling opioid distribution to patients. 23 This results in great responsibility as pharmacists must assess if opioid therapy is suitable for their patients;not properly doing so can carry dire consequences. Pharmacists must openly communicate with patients and other patient care team members in managing patient pain to avoid undue outcomes and unnecessary opioid prescription while fulfilling patient needs.…”

Section: Resultsmentioning

confidence: 99%

The Role of the Pharmacist in Combating the Opioid Crisis: An Update

Kosobuski

O’Donnell

Sharp

et al. 2022

SAR

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The opioid overdose crisis has claimed hundreds of thousands of lives in the United States in the last decade, with overdose numbers continuing to climb. At the same time, the role of the pharmacist in combating the opioid crisis continues to evolve. Methods: A literature search was conducted in Ovid MEDLINE that incorporated both MeSH terms and keywords to describe two concepts: the opioid epidemic and pharmacists/pharmacies. The search was limited to articles published after 2010 through the end of 2021 and returned 196 articles that were analyzed thematically. Results: Thematic analysis revealed the following themes: prevention, interventions, public health role of the pharmacist, pharmacists in multiple roles, barriers, pharmacist and healthcare provider attitudes, educational initiatives for pharmacists and student pharmacists, and future research. Discussion: While a great deal of progress has been made in the role of the pharmacist in supporting individuals with opioid use disorder (OUD) in the last two decades, pharmacists must seek to invest time and resources into practices with a strong evidence base to better mitigate the growing, devastating impact of the opioid crisis. Pharmacists must be willing to embrace new and non-traditional roles in patient care, service and research, and seek to advance evidence-based knowledge and practice. Conclusion: Pharmacy practice has expanded greatly in the past decade with pharmacists taking on new and creative approaches to addressing the opioid crisis. Collaborative and interdisciplinary approaches to addressing the root causes of opioid misuse and opioid overdose are still desperately needed. These include attention to the critical roles of social determinants of health, stigma elimination, legislative advocacy for patients with OUD, and focused education for providers, pharmacists, and the community. Recognition and support of the value of collaboration to both improve public health and individual patient care, continued investments in pharmacy practice advancement in OUD treatment and harm reduction, and the creation of workflows and prescribing algorithms to assist in dosing medications to prevent withdrawal symptoms and achieve improved pain control are desperately needed.

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“…Among these fatalities, 16,706 were specifically linked to opioids obtained with a prescription (NIH, 2023). Surgical specialties account for one-third of these prescriptions (Goldman et al, 2022). Hence, providers bear the responsibility to not only to effectively treat pain, but also to do so in a safe manner.…”

Section: Problem Descriptionmentioning

confidence: 99%

Implementing an evidence-based guideline to decrease opioids after cardiac surgery

Galao-Malo,

Davidson,

D'Aoust

et al. 2024

J Am Assoc Nurse Pract

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Background: Deaths related to overdoses continue growing in the United States. The overprescription of opioids after surgical procedures may contribute to this problem. Local problem: There is inconsistency in the prescription of opioids in cardiovascular surgery patients. Recommendations regarding the reduction of opioids at discharge are not fully implemented. Methods: This is a single-center, pre–post quality improvement project in adult patients after elective cardiac surgery through sternotomy. Interventions: Changes in guidelines, modification of order sets, creation of dashboards, and education to the providers to increase the prescription of acetaminophen around the clock on the step-down unit and at discharge, decrease the number of opioid tablets to 25 or less at discharge and decrease the prescription of opioids to 25 or less morphine milligram equivalents (MME) at discharge. Results: The preintervention group included 67 consecutive patients who underwent cardiac surgery from November to December 2021. The postintervention group had 67 patients during the same period in 2022. Acetaminophen prescription on the step-down unit increased from 9% to 96% (p < .001). The proportion of patients discharged with 25 or less opioid tablets increased from 18% to 90% (p < .001) and with 25 or less MME from 30% to 55% (p < .01). Acetaminophen prescription at discharge increased from 10% to 48% (p < .001). Conclusions: Our intervention increased the use of acetaminophen and decreased the overprescription of opioids in cardiac surgery patients at discharge. Further research is necessary to continue improving pain management to reduce the number of opioids prescribed at discharge.

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Opioid prescribing in the U.S. Military Health System, 2014 to 2018: fewer prescriptions, fewer pills, and shorter treatment duration

Cited by 9 publications

References 26 publications

Naloxone prescribing practices in the Military Health System before and after policy implementation

Naloxone prescribing practices in the Military Health System before and after policy implementation

The Role of the Pharmacist in Combating the Opioid Crisis: An Update

Implementing an evidence-based guideline to decrease opioids after cardiac surgery

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