Opioid Prescribing and Chronic Pain in the Primary Care Setting

Project Summary/Abstract Amidst high levels of chronic pain, the United States (U.S.) has seen a concurrent opioid overdose epidemic that has led to the deaths of an estimated 702,000 people between 1999 and 2017.

In response to the dramatic rise in opioid-related overdose deaths, a large proportion of interventions have targeted opioid prescribing and pain management.

State, federal, and professional organization agencies have implemented changes intended to curb inappropriate opioid prescribing, particularly in the primary-care setting.

This includes the release of the CDC Guideline for Prescribing Opioids for Chronic Pain in March 2016, a set of recommendations for primary-care opioid use in pain management. Between 2012 and 2018, U.S. opioid prescribing rates have subsequently fallen by more than one third.

These changes have affected the estimated 1.6 million people with opioid use disorder and 50 million people with chronic pain.

Concerns about the misapplication of guidelines have arisen, particularly in decisions to reduce or discontinue opioid prescribing among patients with chronic pain.

The overall goal of this study is therefore to better characterize the impacts of new opioid prescribing guidelines and associated prescribing patterns for the treatment of chronic pain in the primary-care setting.

All three specific aims draw from a hospital-system cohort of primary-care patients with chronic pain who are prescribed chronic opioids.

Aim 1 consists of an interrupted time-series analysis to determine the magnitude of changes to opioid prescribing by dose, duration, and prescription type after the implementation of new opioid prescribing guidelines.

Aim 2 entails semi-structured interviews with patients with chronic pain to explore the impact of prescribing and pain management changes on quality of life, functioning, pain management, opioid use, healthcare utilization, and perceptions of health equity.

Aim 3 involves mediation analysis to determine whether certain patient groups have been disproportionately affected by opioid prescribing changes, particularly by race or socioeconomic status.

The proposed research thus aligns with the National Institute on Drug Abuse?s (NIDA) stated goal to better understand the consequences of recent clinical care guideline implementation on opioid prescribing for pain management as well as its mission to support clinical research on substance use and associated disorders.

The fellowship training plan includes rigorous methodological training in quantitative epidemiological and clinical ethnographic methods in a vibrant, multidisciplinary training environment.

Through training and research, this proposal will help to better characterize the effects of recent efforts to reduce inappropriate opioid prescribing and the associated impacts on patient safety, patient wellbeing, and health equity.

Such knowledge has the potential to improve chronic pain care and outcomes, promote responsible opioid prescribing, and lessen health disparities in the primary-care setting.