A care plan created by both physician and patient that outlines treatment goals, medication regimens, and standardized refill procedures is at the center of a new initiative aimed at making the long-term use of prescription opioids safer.

The initiative, developed by Group Health, a Seattle-based nonprofit healthcare system, is described in the August issue of Health Affairs.

According to Michael R. Von Korff, ScD, senior investigator at the Group Health Research Institute, Seattle, Washington, the practice of prescribing opioids for long periods can have adverse and serious consequences. Something needed to be done to try to improve their safety, especially when used in the context of chronic, noncancer pain.

Since the 1980s, the use of opioids for noncancer pain has increased throughout the United States, despite the absence of any strong evidence that they are effective and without knowledge of ways to deliver these drugs safely and effectively, Dr. Von Korff told Medscape Medical News.

In the last decade it has become apparent that there are significant problems with long-term use, defined as 70 to 90 days or more, of opioids.

More Fatalities Than Heroin, Cocaine

"There are problems with diversion, of adolescents abusing or misusing them, and there is also a national epidemic of fatal drug overdose involving prescription opioids. In fact, there is a bigger problem with prescription opioids than there is with heroin or cocaine in terms of fatal overdose," he said.

These concerns prompted Dr. Von Korff and his colleagues to develop a new program to promote the safe use of opioids and prevent their misuse and abuse.

The new program, which began in September 2010, involves Group Health's primary care physicians and the 7000 patients in their care receiving long-term opioid therapy.

Under the initiative, a single clinician is deemed responsible for managing each patient's medication plan. The plan includes the treatment regimen, a monitoring plan for follow-up, including a schedule of return visits, and a revised drug refill schedule.

"These are basic things that often don't happen in a regular practice setting," said Dr. Von Korff. "Sometimes a patient gets opioids from multiple physicians or gets unauthorized refills if there is not a care plan. We are making sure that their care is well organized."

The change has made it easier for patients to get refills. Instead of every 30 days, refills are now based on a 7-day interval and must be ordered in advance.

"When refills were based on a 30-day supply, a patient who picked up a prescription on a certain day could end up running out over the weekend in the following month, so the refill interval was shifted to a multiple of 7 days. The aim of the changes is to ensure that patients are managed in a more orderly, planned way," Dr. Von Korff said.

Dangers Go Beyond Addiction

Patients are also educated about the adverse effects of opioids.

"These include more than just the danger of addiction. Sometimes people drink alcohol, not realizing that alcohol interacts with opioids. Or they will keep them in the medicine cabinet or other easily accessible place, not realizing that these drugs have street value and someone could take them out of the medicine cabinet," said Dr. Von Korff.

"We also educate them about the warning signs of addiction. It isn't typical for patients to develop drug addiction problems, but it is not rare either," he added.

Commenting on the new effort by Group Health, Alec O'Connor, MD, MPH, from the University of Rochester School of Medicine and Dentistry, New York, said the paper "describes a thoughtful, multifaceted approach intending to maximize the benefit and appropriate availability of opioid analgesics while limiting the risks of abuse and diversion."

Dr. Von Korff and Dr. O'Connor have disclosed no relevant financial interests.

Health Aff (Millwood). August 2011;30:1420-1424.

Fran Lowry • Medscape Medical News © 2011 WebMD, LLC