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Acute Opioid Prescribing: Safe Practices

Acute Opioid Prescribing: Safe Practices

The use of opioids in the treatment of acute pain has come under increased attention. In response to the state’s initial plan to require prior authorization for all opioid prescriptions and a hard pill limit, the WSMA worked with the Department of Health and Washington State Hospital Association to establish prescribing guidelines of three days for pediatric patients (≤ 20 years old), and seven days for adult patients. As part of that agreement, we began providing feedback reports on prescribing within these guidelines.

Safety Guideline

New patients who have not previously been on opioid medications should generally be prescribed less than seven days for adults (42 doses of five MEDs) and three days (18 doses of five MEDs) for pediatric patients.BPBT Acute Opioid Prescribing Reports:

  • Launched in 2018, the BPBT Acute Opioid Prescribing Reports provide feedback on the number of prescriptions written by prescribers and the percentage of prescriptions above guidelines.
  • Each quarter, the WSMA distributes individual prescriber reports by email for free. Prescribers may monitor their prescribing over time and, if appropriate, make changes.
  • Data definitions and metric specifications are available.

Quick Facts

  • Risk of opioid use at one and three years increases with the duration of the first prescription for acute opioids.i
  • The risk begins to increase linearly at five days of initial prescribing, reaching a 25% one-year risk when the initial prescription is 30 days.i
  • Pediatric risk of opioid prescribing is greater than adults. Even a prescription validly given after surgery resulted in a risk of persistent opioid use of 5%.ii
  • A high percentage of opioid users, including 75% in one study, cited their initial exposure to opioids being from a legitimate prescription.iii
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Resources and References

Resources

The following are examples of prescribing guidelines and literature reviews for those considering establishing an opioid prescribing policy.

Michigan OPEN Procedure Based Guidelines. Specific recommendations for procedural prescribing opportunities for surgeons.

WSMA Washington Pain Management Rule Requirement Checklist. WSMA resource for use by members on how to be in compliance with prescribing rules.

Prescription Drug Monitoring Program. Review opioid prescribing for a patient or your personal opioid prescription history.

May 2020 Webinar on the Washington State Opioid Reports
Learn more about the Washington State Opioid Prescribing Reports program and the Six Building Blocks program. This webinar was originally broadcasted on May 15, 2020. Webinar presenters were Nathan Schlicher, MD, JD, BPBT physician lead; Jeb Shepard, WSMA director of policy and regulatory affairs; Laura-Mae Baldwin, MD, UW family medicine and the Six Building Blocks program; and Michael Parchman, MD, MPH, Kaiser Permanente Health Research Institute and the Six Building Blocks program.

Complying with State Opioid Regulations through Improved Prescribing Practices – WSMA members only—sign-in required WSMA's free one-hour on-demand webinar can help clinicians understand how to comply with the new requirements. Completion of the webinar will fulfill the new state requirement for continuing medical education on opioid prescribing. This activity has been approved for AMA PRA Category 1 Credit™. After completing the activity, learners should be able to:

  • Review the Washington state opioid prescribing requirement.
  • Outline strategies to comply with specific requirements of opioid prescribing rules.
  • Detail additional resources available for up-to-date evidence-based information on opioid prescribing.

UW Six Building Blocks

Self-Service How-to Guide for the Six Building Blocks Program

WSU Interprofessional Team-Based Opioid Education

Washington State Opioid Rules and Best Practices - developed by UW
We aim to ensure our health care professionals who prescribe opioids for pain for any indications are doing so safely and according to state rules and best practices for pain management. This module is consistent with an emerging national consensus by the Centers for Disease Control and Prevention, Food and Drug Administration, and professional pain societies regarding best practice guidelines for health care professionals for management of patients receiving opioid prescriptions regardless of formulation or type of pain.

Pain and Opioid Consult Hotline for Clinicians
A resource developed by UW Medicine and funded by the state. It aims to provide answers and help Washington state clinicians with opioid questions and concerns about patients under their care.

References

i. MMWR Morbidity and Mortality Weekly Report. V 66, no 10.

ii. Lankenau SE, Teti M, Silva K, et al. Initiation into Prescription Opioid Misuse among Young Injection Drug Users. Int J Drug Policy, 2012 January; 23 (1): 37-44.

iii. Harbaugh CM, Lee JS, Hu HM, McCabe SE, et al. Persistent opioid use among pediatric patients after surgery. Pediatrics. 2018 Jan; 141 (1): e20172439.

iii. Michigan OPEN Procedure Based Guidelines. Specific recommendations for procedural prescribing opportunities for surgeons.

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