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Could Care Structure Change Opioid Practice?

February 15, 2018
A rural primary care office tested pain management and weaning through a proposed office model.

A PPM Brief

A recently published retrospective study led by McCann et al of Marshall University, West Virginia, examined the choice of care structure among patients on opioid medication for nonmalignant chronic pain. Subjects were already enrolled in an individual primary care physician’s practice and required to engage with a new care system.

Enrolled patients could choose to:

  • remain on opioids
  • wean opioids
  • transfer care.

Patients who remained in the practice and continued taking opioids were required to come in once every three months. According to the paper, visits included a review of the physician-patient controlled substance contract, urine drug screen, Board of pharmacy monitoring, pain-targeted history and physical, calculation of the average morphine equivalents used, and evaluations of overall pain, function, and mood.

Of those enrolled (n = 32), 38% elected to wean opioids, 53% continued opioid medication, and 9% chose to transfer to another practice. Mean morphine equivalent (mg/day) was used to determine wean ability (17.01 mg/day) compared to maintaining opioid management (30.61 mg/day) (P = 0.0397; CI, 0.68 to 26.51).

“Patients maintaining opioid treatment showed no statistically significant change in any measured data point from beginning until end of the evaluation period. Given the choice of following a specific structured care system of opioid medication management or leaving the practice, most patients agreed to the structured system,” concluded the authors. The utilized model led to a reduction in opioid prescriptions and a greater likelihood of weaning from opioids.


Last updated on: February 16, 2018
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