Group Health has claimed the lead in helping primary care doctors to reduce the risks of opioid use for chronic pain. Over the past nine months, doctors in the Seattle-based health system have worked with nearly 6,000 patients to create care plans for the safe use of opioid painkillers for their chronic non-cancer pain.
The care plans involve educating patients who use opioid painkillers for more than 90 days about the risks and creating modified procedures for short-term refills as well as scheduled visits to monitor pain control. A report of the program appeared August 5 in Health Affairs.
The Group Health team moved aggressively to follow their own advice, published in the conclusion to their report last year in the Annals of Internal Medicine, which showed that overdose deaths from opioid painkillers are most likely among patients prescribed high doses. Careful vigilance is crucial to avoid such fatalities, they wrote. (Another group from the University of Michigan reported similar results in JAMA two months ago.)
A recent consensus report from the US Institute of Medicine urged more attention to chronic pain as a public health problem. It called for "transformational change" in the way chronic pain is diagnosed and treated, with a "comprehensive strategy" for research and better collaboration between primary care doctors and pain specialists. But inevitably, such transformation will be slow. It may not be straightforward for doctors to arrange alternative therapies for a patient in chronic pain, or for patients to achieve sustained changes in lifestyle and exercise.
For those who continue to need heavy-duty painkillers, and their doctors, the Group Health approach is easily available. Its guidelines for creating a care plan for safe use of opioids, and and a related educational program, are both available online.