Presented at the 2013 AAPM Annual Meeting « Back

Comparison Opioid Prescribing Guideline Violations by Clinical Specialty

Chia-Chen Teng, MSTAT, chia-chen.teng@va.gov¹, Christy Porucznik, PhD MSPH¹, Erin Johnson, MPH², Robert T. Rolfs, MD MPH², Brian C. Sauer, PhD¹, (1) University of Utah, Salt Lake City, Utah, (2) Utah Department of Health, Salt Lake City, Utah

Objective: The objective of this analysis was to quantify the contribution of clinical speciality to the proportion of chronic opioid users who experienced unsafe prescribing according to the Utah Opioid Prescribing Guidelines that were promulgated in April of 2009. Methods: This study was IRB approved by the University of Utah. Multiple data sources were used for this analysis. Patient- and provider-level prescribing data were obtained from our prescription-monitoring program, the Utah Controlled Substances Database (CSD). ED visits were obtained using the Utah ED encounter database and information on opioid deaths was obtained from the state medical examiner database. Process flags included the dual use of long acting opioids and combined use of benzodiazepines and long acting opioids. Opioid uses were categorized as acute, intermittent, chronic or palliative. This analysis, however, was restricted to prescribing violations in chronic opioid users during the period of 04/2009 to 03/2010. Results: There were 36,364 patients who received opioids who were classified as chronic users during the study period. Long acting opioids were dispensed for 16,618 of these patients. Providers were involved in 953 long acting poly pharmacy flags and 8,198 long acting opioid and benzodiazepine flags. Nurse practitioners and pain medicine physicians had the highest proportion of chronic pain patients with long acting opioid flags. See figures 1 and 2. Conclusion: Nurse practitioners and pain physicians may need additional counseling on the Utah opioid prescribing guidelines and should review their panel of patients to ensure poly pharmacy is appropriate.

Funding: CDC R21