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Higher dosages of opioids are associated with higher risk of overdose and death—even relatively low dosages (20-50 morphine milligram equivalents (MME) per day) increase risk. Higher dosages haven’t been shown to reduce pain over the long term. One randomized trial found no difference in pain or function between a more liberal opioid dose escalation strategy (with average final dosage 52 MME) and maintenance of current dosage (average final dosage 40 MME).
CDC Guideline for Prescribing Opioids for Chronic Pain Opioids are commonly prescribed for pain. An estimated 20% of patients presenting to physician offices with non-cancer pain symptoms or pain-related diagnoses (including acute and chronic pain) receive an opioid prescription (1). In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills (2).
CDC Online Training Program for Opioid Prescribing More than 40 people die every day from prescription opioid-involved overdose. The CDC Guideline for Prescribing Opioids for Chronic Pain provides recommendations for safer and more effective prescribing of opioids for chronic pain in patients 18 and older in outpatient settings outside of active cancer treatment, palliative care, and end-of-life care.
Collaborative Care for Chronic Pain Report and Recommendations from the Bree Collaborative Treatment of pain varies widely between systems and clinicians with high financial and human cost. Moving to a collaborative or team-based approach to managing complex pain has been shown to result in better patient outcomes. However, most approaches to pain management including chronic opioid therapy involved siloed health care providers. This workgroup met from January 2018 to January 2019 and defined minimum standards for:
Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care The SUMMIT Randomized Clinical Trial
Collaborative Care for Opioid and Alcohol Use Key Points Question: Does collaborative care for opioid and alcohol use disorders increase treatment use and self-reported abstinence compared with usual primary care?
Collaborative care has a way of stretching the skill sets of all involved. Over the past few years, we have come to realize the importance of treating not only common mental disorders but also addiction problems in primary care. Mark Duncan, M.D., shares his experience treating patients with substance use disorders in a collaborative care model and shows us that leveraging the strengths of collaborative care for addiction treatment has much promise. —Jürgen Unützer, M.D., M.P.H.
New Opioid Pain Management Guide Recommends Telehealth Patient Care Due to the COVID-19 pandemic, primary care physicians should provide opioid therapy for their patients through telehealth visits using two-way video such as Skype or FaceTime, or by telephone, according to a new guide issued by the AHRQ-funded Six Building Blocks program.
Implementing Medication-Assisted Treatment for Opioid Use Disorder in Rural Primary Care: Environmental Scan Volume 1
The environmental scan demonstrates that, while offering MAT services in rural primary care settings may appear complex, many primary care providers view it as the treatment and "long-term management" of a chronic recurring disorder. Thus, in many ways, it is similar to the treatment they already provide for patients with asthma, diabetes, hypertension, and other chronic health conditions.
Implementing Medication-Assisted Treatment for Opioid Use Disorder in Rural Primary Care: Environmental Scan Volume 2 Tools and Resources
A variety of tools and resources are available for providers and patients who offer or use medication-assisted treatment (MAT) services. As part of this environmental scan, a list of tools has been assembled for use in the implementation of MAT. Although the tools were not all created specifically for rural primary care practices, they are potentially useful in those and other settings. The tools and resources found by this environmental scan are listed and described in the tables that follow. They come from a variety of public and private sources.
A number of MAT models of care have been developed and implemented in primary care settings. Research is needed to clarify optimal MAT models of care and to understand effective strategies for overcoming barriers to implementation. The models of care presented in this technical brief may help inform the individualized implementation or MAT models of care in different primary care settings.