Sept 9, 2016

Majority of patients on lowest dosage per day

LAS VEGAS — The majority of patients at a large urban safety-net health system are being treated with the lowest dose of opioids per day, despite all the challenges those providers face, a retrospective chart review of a prescription drug database found.

The median milligrams morphine equivalent (MME) per day for this population was 18.75, with 59% of patients prescribed less than 20.0 MME per day, while 39% were prescribed 20-49, and only 2.0% on a dose greater to 50 MME per day (the highest risk of accidental opioid abuse), reported Kelley W. Carroll, MD, of McGovern Medical School at UTHealth in Houston, and colleagues.

Harris Health System is a network of hospitals, community health centers, school-based clinics, and homeless clinics serving 300,000 patients, with 54,000 pain patients — a small amount of the total population. At a poster presentation at Pain Week, Carroll told MedPage Today that these results showed their health system was doing a very good job at taking care of these types of patients, despite the numerous financial challenges they face. These include having no pain specialists on staff, a 70% uninsured patient rate and being unable to afford urine/drug testing (only urine/drug screening).

“I was surprised – I thought the median was going to be higher — I thought there were going to be more high-risk patients, so I was very pleasantly surprised,” she said. “The primary care providers have to take care of the chronic pain patients, so my interest in this is how are they doing in terms of coping and taking care of the patients in a safe manner.”

Carroll and colleagues also examined the opioid prescription distribution by age, because elderly patients are more prone to respiratory depression, and found similar, somewhat reassuring results. While patients ages 65 years and older comprise 15% of patients, they comprised only 8% of those receiving opioid prescriptions.

In fact, 67% of patients over age 65 received the lowest dose of opioids (<20 MME/day) compared with a slightly lower portion of 45-64 year olds (59.0%) and patients under 44 years of age (56.8%).

Overall, 18,000 patients were considered chronic opioid users (defined as three prescriptions or more), but Carroll said that was a number she could work with.

“It’s such a small number of patients, I can very easily be monitoring those patients through our EMR [electronic medical record],” she said.

Carroll’s next steps for this research include examining several other sociodemographic factors that may be contributing to opioid prescribing, including trends by department.

“My hypothesis is the high-risk patients are the palliative care patients, oncology patients who appropriately should be getting high doses, and most of the low-risk [patients] should be coming from primary care,” she said. “I also want to look at ethnicity and look at gender to see if there’s any difference there.”


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