Developing an interprofessional team to support patients prescribed long-term high-dose opioid therapy

Area of Science:

• Pain Management
• Pharmacology
• Public Health

Background:

• Opioid prescribing rates remain high despite decreases, with daily morphine milligram equivalents (MME) significantly elevated compared to 1999.
• Long-term high-dose opioid (HDO) use presents significant risks, necessitating specialized management strategies.

Purpose of the Study:

• To evaluate the effectiveness of an interprofessional team (IPT) in managing adults prescribed long-term HDO (exceeding 50 daily MME).
• To support safer, evidence-based pain management through patient education and individualized care planning.

Main Methods:

• An interprofessional team (IPT) comprising a clinical pharmacist, addiction nurse, medical director, and physician/NP managed patients on long-term HDO.
• Patient visits focused on education regarding HDO risks and pain management strategies.
• Care planning included opioid tapers, non-opioid pain medications (NOPM), non-pharmacological therapy (NPT), and naloxone co-prescribing.

Main Results:

• The IPT successfully engaged 90% of eligible patients.
• Excluding outliers, the cohort showed an average 18% decrease in daily MME.
• Commonly utilized NOPM included acetaminophen, NSAIDs, and pregabalin; NPT included physical, aquatic, and behavioral therapies.

Conclusions:

• An IPT model is effective in reducing daily MME for patients on long-term HDO.
• Shared decision-making, collaborative teamwork, and patient-centered goals are crucial for transitioning patients to safer, evidence-based pain management.
• This approach facilitates safer opioid management in primary care settings like Federally Qualified Health Centers.