Controlled Substance Agreements for Opioids in a Primary Care Practice

Area of Science:

• Pain Management
• Primary Care Medicine
• Pharmacology

Background:

• Opioids are frequently prescribed for chronic non-cancer pain (CNCP).
• Controlled substance agreements (CSAs) aim to improve adherence and reduce risks associated with opioid therapy.
• This study examines demographic characteristics and opioid dosing in CNCP patients under CSAs within a primary care setting.

Purpose of the Study:

• To evaluate demographic characteristics and opioid dosing patterns among patients with CNCP enrolled in CSAs.
• To identify factors associated with higher opioid MME/day in this patient population.
• To explore the potential of CSAs for managing opioid therapy in primary care.

Main Methods:

• Retrospective cohort study of 1066 patients enrolled in CSAs for CNCP.
• Data collected from a Midwest primary care practice between May 2013 and August 2016.
• Analysis of demographic factors, opioid dosage (MME/day), comorbidities (Charlson Comorbidity Index), and tapering plans.

Main Results:

• Average daily opioid dose was 40.8 MME/day, with 21.5% receiving ≥50 MME/day and 9.7% receiving ≥90 MME/day.
• Younger age (<65 years), male gender, tobacco use, and higher comorbidity scores (CCI > 3) were associated with significantly higher MME/day.
• Patients on a tapering plan received higher MME/day than those not on a plan.

Conclusions:

• CSAs provide a platform for discussing opioid safety, appropriate dosing, and tapering with patients on higher opioid doses.
• Leveraging CSAs can facilitate a population health management approach for CNCP patients.
• Further research into optimizing CSA utilization for risk mitigation and patient care is warranted.