Monitoring and intervention to increase safety and reduce abuse

One of the pressing issues in American clinical medicine is finding the right balance between appropriate pain management and the risk of opioid diversion and substance dependence. Approximately 10% of Americans take prescription pain medication regularly to manage chronic pain, but many of these medications are misused or diverted for illegal recreational purposes: there are now more ER visits for prescription drug-related problems than for illegal drugs, and drug overdose is now the second leading cause of unintentional death – just behind motor vehicle accidents. This healthcare concern crosses age and demographic boundaries and has consequences beyond addiction.

Missouri implemented CMT’s Opioid Prescription Intervention™ (OPI) in 2010 to address these issues and to accomplish the following goals:

  • Target and Reduce Opioid Abuse: OPI identifies patients at higher risk of opioid abuse or dependence, as well as physicians whose prescribing patterns suggest a need for focused interventions
  • Reduce adverse affects, particularly in special populations: Children, the elderly population and individuals with certain diagnoses are at higher risk for the adverse side effects of opioid use. OPI helps identify and reduce the risk of side effects from opioid use in special populations.
  • Identify Prevention Opportunities: OPI provides opportunities for early identification and intervention of patients at risk for developing chemical dependency and addiction.

Selected prescribers of opioids in Missouri receive packets of educational information on a monthly basis identifying patients who are at potential risk for abuse, dependence, or adverse side-effects, and highlighting prescribing practices that are potentially at odds with the above goals. As with Behavioral Pharmacy Management™ (BPM), OPI packets contain collegially written Clinical Considerations™ with supporting citations from the medical literature, and a detailed 90-day pharmacy history, which includes a list of all providers of opioid medications to affected patients. The OPI has been very positively received by physicians in Missouri.