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National opioid prescribing behaviors have improved—5 imperatives to keep the momentum going

October 8, 2019

    National opioid stewardship efforts appear to be paying off, but there's still plenty of room for improvement, especially for the treatment of opioid use disorder (OUD).

    We recently updated our Opioid Population Profiler tool to include 2018 data. The tool reports on 29 key performance indicators (KPIs) by county, state, and the country overall, enabling users to assess local performance, track changes over time, and prioritize improvement opportunities.   

    Access the Tool

    Key improvements

    From 2017 and 2018, the greatest improvements were in the number of initial opioid prescriptions that complied with CDC recommendations (75% in 2018, up from 57% in 2017). The recommendations were issued in early 2016 for primary care clinicians treating chronic pain (rather than patients who are in active cancer treatment or experiencing either acute sickle cell crises or post-surgical pain). Specifically, the data show that clinicians—at both national and regional levels—wrote shorter initial opioid prescriptions (<50 MME/day or less) at lower doses (seven-day supply or less).

    Additionally, the national data (averages) show improvements in the:

    • Number of new opioid fills (99.8 per 1,000 people, down from 115.8 per 1,000 people);

    • Number of new opioid fillers who avoid chronic use (99%, up from 98.6%); and

    • Avoidance of opioids for new low back pain patients (91.2%, up from 88.5%).

    Areas for improvement

    However, while behavior surrounding initial prescriptions has improved (likely because of clear guidance that resulted in clinicians prescribing fewer opioids and insurers providing less coverage for opioids), there is opportunity for clinicians to improve ongoing management of patients taking opioids, dealing with chronic pain, or suffering from OUD. Specifically, providers should focus on:

    1. Increasing naloxone fills among patients with OUD or opioid overdose (only 3.4% of cases show evidence of a fill);

    2. Optimally managing chronic pain treatment with opioids (only 11.1% of patients are considered optimally managed);

    3. Increasing use of non-pharmacological therapy for pain among chronic opioid users (national average is only 25.3%);

    4. Increasing use of medication-assisted treatment (MAT) among patients with OUD or opioid overdose (only 35.1% of cases show evidence of MAT); and

    5. Increasing appropriate contact with patients before second opioid prescriptions (55% of patients have appropriate contact).

    Additionally, maintaining contact with chronic opioid users (defined as discussing opioid use every three months) is especially important, as the prevalence of OUD was the only one of 29 measures included in the tool that did not improve or hold steady. However, higher prevalence may be due to improved identification of OUD rather than a true increase in the number of cases.

    Of course, there are other measures of opioid stewardship not included in the tool that reflect how far we have to go. For example, there was an increase in fentanyl-related deaths in 2017 and many patients still lack access to evidence-based treatment for OUD.

    We'd encourage leaders to view the positive news as reinforcement for stewardship efforts to date, but to continue investing heavily in efforts to sustain these improvements, while tackling new initiatives in 2020. To aid prioritization, we recommend that health system leaders use the tool to compare their market performance across each county in their region and how that performance compares to surrounding geographic areas and the nation overall.


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