Evidence-based Toolkit for Reduction of Overdose Risk in Primary Care Patients on Opioid Therapy

Introduction: Opioids are powerful pain killing medications that can be highly addictive and can cause risk for overdose and even death (Michigan Prescription Drug and Opioid Task Force, 2015). Many primary care providers treat patients with acute and chronic pain, although it is recognized that many receive inadequate training in pain management and feel unprepared in the complexities of caring for these patients (Becker, Bair, Picchioni, Starrels, and Frank, 2018). To treat these patients safely, provider education and adherence to guidelines put forward by these initiatives is essential. Methods: An evidence-based prescribing toolkit was devised using guidance from the literature and was presented to prescribers in two northern Michigan primary care offices. The goal was to increase provider comfort level with opioid prescribing in primary care, as well as to increase adherence to organizational policy, using several metrics. Discussion, survey, and chart audits were used for evaluation. Results: Compliance with the Opioid Start Talking Documentation and Medication Contract use increased post implementation (p \u3c 0.05, ; x2=3.95, p0.05). In addition, benzodiazepine co-prescription rates did not statistically differ pre- and postimplementation (p \u3e0.05). Provider comfort level increased slightly but was not significant. Conclusion: The evidence-based toolkit was effective at increasing organizational adherence but not provider comfort level. Reduction of morphine milliequivalents and co-prescribing are promising concepts that will likely improve over time