PRESTO: Promoting Engagement for the Safe Tapering of Opioids

Area of Science:

• Medical Education
• Public Health
• Pharmacology

Background:

• Opioid overdose deaths remain a significant public health concern, with prescription opioids implicated in 24% of fatalities.
• Changing prescribing practices is crucial for reducing opioid-related mortality.
• Primary care providers (PCPs) often require enhanced patient engagement skills to manage opioid tapering effectively.

Purpose of the Study:

• To evaluate the impact of the PRomoting Engagement for Safe Tapering of Opioids (PRESTO) protocol on PCP opioid-prescribing patterns.
• To assess changes in PCP confidence and patient engagement regarding opioid tapering after training.
• To determine if the PRESTO protocol influences buprenorphine prescribing.

Main Methods:

• A time series trial was conducted involving 148 Ohio PCPs.
• The study compared opioid prescribing patterns 8 months before and 8 months after PRESTO protocol training.
• Training was modeled on the evidence-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach.

Main Results:

• PCPs completing PRESTO training reported increased confidence in discussing opioid overdose risk and tapering.
• A decrease in overall opioid prescribing was observed among participants, but it was not statistically significant compared to non-trained PCPs.
• A small but significant increase in buprenorphine prescribing was noted among PCPs who completed the PRESTO training.

Conclusions:

• The PRESTO protocol enhances PCP confidence in managing opioid tapering.
• While overall opioid prescribing changes were not significant, the protocol shows promise for increasing buprenorphine prescribing.
• Further research and validation of the PRESTO approach and the opioid risk pyramid are warranted.