MGMA: 6 ways medical practices can combat opioid epidemic

From sticking with opioid alternatives to reducing prescription sizes, there are multiple strategies medical practices can use to help curb patient misuse of these drugs, according to a new report released by the Medical Group Management Association (MGMA).

Based on survey responses and interviews with 43 practice managers across the country, the MGMA report was compiled to identify best practices and challenges practices face in coping with the country’s opioid epidemic.

"Our goal with this report was to find the best ways in which medical practices and healthcare providers—those on the frontlines—can drive meaningful parts of solving this crisis,” said Halee Fischer-Wright, the MGMA’s president and CEO, in an announcement.

Based on the research, the MGMA said practices can follow these principles when developing or modifying an opioid prescription policy.

1. Consider alternatives to opioids. Opioid therapy should not be a first-line treatment for chronic pain. If needed, opioid therapy should be combined with preferred nonpharmacologic therapy and other nonopioid medications.

2. Have a plan to discontinue opioid therapy. Treatment plans should include when and how opioids will be stopped as patients near their care goals.

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3. Educate patients and periodically evaluate opioid use. “There is never a bad time to address the risks of opioid misuse with the patient, whether before beginning therapy or while managing therapy,” the report said. Doctors should evaluate the benefits and harms of opioids between one and four weeks after the start of therapy and after any increase in dosage.

4. Prescribe proper doses of opioids and for the proper duration. Immediate-release opioids at the lowest effective dosage are preferred for starting therapy, and doctors should prescribe them in the lowest quantity to manage pain that is severe enough to require opioids.

5. Check state prescription drug monitoring programs before starting a patient on opioids and periodically thereafter. Additionally, test a patient's urine for drugs before starting opioid therapy, with periodic testing at least annually.

6. Be ready to handle patient misuse of opioids. Clinicians should be prepared to offer or arrange treatment for patients with opioid use disorders. That may include buprenorphine or methadone, along with therapy for behaviors tied to substance misuse.

The majority of practices have taken steps to help control the opioid epidemic. A November Stat poll found that 83% of practices said they have taken steps to tighten protocols on prescribing opioids and 61% of practices that do prescribe opioids educate patients on the potential misuse of the drugs.

In a separate survey earlier this year conducted by the physician social network SERMO, some 69% of the more than 3,000 doctors who responded said they reduced their opioid prescribing or stopped prescribing the painkillers.