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Opioid receptors, including the mu (μ, MOR), delta (δ, DOR), and kappa (κ, KOR) types, belong to the rhodopsin family of G protein-coupled receptors. These receptors are located throughout the central and peripheral nervous systems and in non-neuronal tissues such as macrophages and astrocytes. Opioid receptor ligands can be categorized into agonists or antagonists. Highly selective agonists include [d-Ala2, MePhe4, Gly(ol)5]-enkephalin or DAMGO for MOR, [D-Pen2,...
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Nursing Clinical Information System (NCIS)
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Comprehensive Approach to Opioid Management in a Primary Care Network.

Robert J Fortuna1,2, Jineane Venci1, Wallace Johnson1,2

  • 1Department of Internal Medicine, University of Rochester, Rochester, New York, USA.

Population Health Management
|January 18, 2024
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Summary
This summary is machine-generated.

A new opioid stewardship program improved adherence to prescribing guidelines, reduced chronic opioid use by 36%, and enhanced patient support for opioid use disorders in primary care.

Keywords:
controlled substanceopioidopioid stewardshippopulation healthprimary care

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Area of Science:

  • Public Health
  • Primary Care Medicine
  • Pharmacology

Background:

  • The opioid epidemic necessitates improved prescribing practices.
  • Adoption of Centers for Disease Control and Prevention (CDC) guidelines for opioid prescribing has been inconsistent.
  • Patients and providers face challenges in implementing opioid management strategies.

Purpose of the Study:

  • To describe the development and implementation of a comprehensive opioid stewardship program.
  • To improve opioid prescribing practices and patient outcomes in a large primary care network.

Main Methods:

  • A 3-tier approach was developed: best practice prescribing, opioid weaning protocols, and support for opioid use disorders.
  • Implementation occurred across 44 primary care practices serving over 223,000 patients.
  • Data were collected from 2018 to 2021.

Main Results:

  • Chronic opioid prescriptions decreased by 36% (4848 to 3106 patients).
  • Use of controlled substance agreements increased from 13% to 83%.
  • Annual urine drug screen completion rose from 17% to 53%.
  • Co-prescribing of benzodiazepines decreased.
  • 6.5% of patients were referred for substance abuse counseling.

Conclusions:

  • The comprehensive opioid management program successfully improved adherence to best practices.
  • The program facilitated appropriate opioid dose reduction and enhanced support for patients with opioid use disorders.
  • Structured opioid stewardship is effective in primary care settings.