Opioid Analgesics in Pain Management Responsible Prescribing for - - PowerPoint PPT Presentation

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Aug 17, 2023 308 likes •500 views

Opioid Analgesics in Pain Management Responsible Prescribing for Our Injured Workers Stephen T. Woods M.D. OPIOID MANAGEMENT TOOLS Pharmacy Benefits Program o Monitoring utilization Providers o Appropriate prescribing Opioid Utilization

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Opioid Analgesics in Pain Management

Responsible Prescribing for Our Injured Workers

Stephen T. Woods M.D.

SLIDE 2

SLIDE 3

OPIOID MANAGEMENT TOOLS

Pharmacy Benefits Program

Monitoring utilization

Providers

Appropriate prescribing

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Opioid Utilization Management Tools

Pharmacy Benefits Program

Closed Formulary
Opioid Trending Report
Controlled Substance Monitoring Program
Point of Service Edits
Drug Utilization Review
Ohio Automated Rx Reporting System (OARRS) monitoring
Medication Therapy Management (MTM)

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Opioid Prescribing Management Tools

Risk assessment tool
OARRS
Urine Drug Screen (UDS)
Patient Pain Treatment Agreement (Pain Contract)
4 “A”s of Pain Management
Activities of Daily Living (ADLs)
Adverse effects
Analgesia
Aberrant behavior

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SLIDE 7

Governor’s Cabinet Opiate Action Team (GCOAT)

Professional Education Workgroup Reforming Prescribing Practices Committee

DRAFT RECOMMENDATIONS 01/04/2013

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Context

Patients with chronic, non-terminal pain

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Trigger

≥ 80 mg morphine equivalent dose (MED)
Average daily dose (over a 90-day period)
OARRS database
#16 Vicodin/Norco 5mg tabs
#11 Percocet 5mg tabs

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Prescriber Actions (Required)

Informed consent
Written safety information
Check OARRS
Pain treatment agreement
Document 4 “A”s

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Prescriber Actions (Suggested)

Reassess pain etiology (exam/Ddx)
Assess addiction risk/mental health concerns
Reassess patient goals
Revisit treatment options
Accountability plan (pill counts, sponsor

supervision)

Taper, wean, rotate meds
Referral to pain mgt or other or 2nd opinion

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Washington State Dept.

f Labor & Industries

Guidelines for Prescribing Opioids to Treat Pain in Injured Workers

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“Good Stuff. If every state, every carrier, every employer enforced (or perhaps were allowed to enforce) such guidelines, we could eliminate a significant portion of the opioid problem in comp.”

Gavin, Michael. (2013 Jan). New Opioid Guidelines: Well Done Washington. Workers’ Compensation Institute360.

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Why?

Functionally based
Tailored to work comp
Proactive
Case definition for discontinuing COT
Rule

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Clinically Meaningful Improvement in Function

Function as metric in measuring success
Function drives utilization
Example: Does it make sense to accept the

risk of the treatment without the reward of function and return to work?

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Triggers

Time based
Acute 0-6 weeks
Sub-acute 6-12 weeks
Chronic >12 weeks
Implementation of tools escalates with each

phase.

Opportunities to wean start early
Chronic treatment limited to 120 MEDs

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Discussion

Case Examples
Question and answer