Presented at the 2013 AAPM Annual Meeting « Back

Evaluating the Impact of the Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain on Opioid Prescribing in Utah, 2002–2009

Brian C. Sauer, PhD, brian.sauer@utah.edu¹, Christy Porucznik, PhD MSPH¹, Chia-Chen Teng, MSTAT¹, Steven G. Pickard, MBA¹, Erin Johnson, MPH², Jonathan Nebeker³, (1) University of Utah, Salt Lake City, Utah, (2) Utah Department of Health, Salt Lake City, Utah, (3) Veterans Administration, Salt Lake City, Utah

Objective: The objective of this analysis was to quantify changes in opioid prescribing and adverse events before guideline development (pre-period) during development and reporting of opioid concerns (intermittent period) and after promulgation of the Guidelines (post-period). Methods: This study was IRB approved by the University of Utah. Multiple data sources were used for this analysis including the Utah Controlled Substances Database (CSD), Utah ED encounter database, and the state medical examiner database. Process flags included the dual use of long-acting opioids or short-acting opioids, combined use of benzodiazepines and long-acting opioids, methadone titration. Outcome flags included the opioid related ED visits and deaths. Opioid users were categorized as acute, intermittent, chronic or palliative. Flags were compared by opioid user type across the pre-intervention period (07/2006-06/2007), intermittent period (08/2007-07-2008), and post-period (04/2009-03/2010). Results: During each period there were approximately 380,000 acute uses, 32,000 chronic, 220,000 intermittent and 5,000 palliative users. Most process and outcome measures improved during the post-guideline periods (Tables 1 and 2). Chronic users had the highest proportion of poly-pharmacy and outcome flags. Opioid users classified as palliative had the highest proportion of initial methadone dosing violations. Conclusions: While the number of opioid users remained constant across time periods there has been a decrease in unsafe use of opioids and opioid-related adverse events in Utah since the opioid prescribing guidelines were promulgated and received media attention.

Funding: CDC R21

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