Patients with opioid use disorder are much more likely than the general population to have a host of other health conditions, including hepatitis C, post-traumatic stress disorder, and anxiety.

That’s according to a new analysis from health care company Amino, which culled data from the claims of 3.1 million privately insured patients between 2014 and 2016. It calculated the frequency of a slew of health conditions — from back pain to binge drinking — in patients diagnosed with opioid use disorder. Then, it compared those rates to the general patient population.

Follow Prescription Advisory

Prescription drug monitoring programs (PDMPs) are now active in most states to assist clinicians in identifying potential controlled drug misuse, diversion, or excessive prescribing. Little is still known about the ways in which they are incorporated into workflow and clinical decision making, what barriers continue to exist, and how clinicians are sharing PDMP results with their patients.

Design
Qualitative data were collected through online focus groups and telephone interviews.

Setting
Clinicians from pain management, emergency and family medicine, psychiatry/behavioral health, rehabilitation medicine, internal medicine and dentistry participated.

Patients
Thirty-five clinicians from nine states participated.

Methods
We conducted two online focus groups and seven telephone interviews. A multidisciplinary team then used a grounded theory approach coupled with an immersion–crystallization strategy for identifying key themes in the resulting transcripts.

Results
Some participants, mainly from pain clinics, reported checking the PDMP with every patient, every time. Others checked only for new patients, for new opioid prescriptions, or for patients for whom they suspected abuse. Participants described varied approaches to sharing PDMP information with patients, including openly discussing potential addiction or safety concerns, avoiding discussion altogether, and approaching discussion confrontationally. Participants described patient anger or denial as a common response and noted the role of patient satisfaction surveys as an influence on prescribing.

Conclusion
Routines for accessing PDMP data and how clinicians respond to it vary widely. As PDMP use becomes more widespread, it will be important to understand what approaches are most effective for identifying and addressing unsafe medication use.

Pain Medicine, Volume 15, Issue 7, July 2014 

What prescribers can do to safely and effectively use opioids for CNCP (includes the following)

  • Screen for prior or current substance abuse/misuse
  • Do not use concomitant sedative–hypnotics or benzodiazepines
  • Track daily MED using an online dosing calculator
  • Use the state Prescription Drug Monitoring Program to monitor all sources of controlled substances

Neurology, 2014; 83; 1277-1284, September 2014
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