Partnering, Not Policing: Using Data to Reduce Opioid Prescribing
DENVER, Jan. 17, 2018 — In our current opioid crisis, clinicians have the very challenging job of balancing the prescribing of pain medications for patients struggling with chronic pain against the continuing rise of opioid overdoses. Many legitimate patients need access to these important medications, but some people try to get their hands on opioid medications with the intent to abuse or sell them.
Uncertainty about patient intent can lead some doctors to fear prescribing opioid medications at all. However, there is a solution that many clinicians and hospital systems see as the right balance, allowing them to practice medicine as they think appropriate while giving them necessary alerts when abuse or drug diversion is probable.
Anthony Mimms, MD and owner of Mimms Functional Rehabilitation in Indiana, started directing the majority of his chronic pain patients to use Cordant Pharmacy Solutions, which specializes in serving pain and substance use disorder patients.
“I chose Cordant because its unique model and detailed reporting supported my goal of appropriately reducing patients’ morphine equivalent dose (MED) levels,” said Mimms.
Cordant began by assessing the risk across Dr. Mimms’ patient population. This included reviewing, in partnership with the staff, the average MED levels of the practice and the state prescription drug monitoring program data, as well as providing reports with individual results and collective practice averages.
Referenced in the chart, in December of 2016, when Mimms’ patients first started using Cordant, almost sixty percent were at 121 MEDs or above, with forty percent of his patients over 201 MEDs. By October 2017 almost sixty percent of Mimms’ patients were between 50 and 90 MEDs and only fifteen percent had MEDs higher than 201.
“Appropriate access to medication with the appropriate controls in place—that is the philosophy our pharmacy and integrated drug testing program is built around,” said Susan Sommer, president and CEO of Cordant. “Clinicians need to be able to practice medicine how they see fit, but they also need to have the right stopgaps in place. It’s not about policing patients with these reports, but when clinicians have easy access to the right information, it helps them determine the best path forward for their patients.”
Dr. Mimms launched his reduction plan with a broad communication strategy of forthright conversations with patients around the risks of long-term opioid use, the option of using alternative medications such as Lyrica and gabapentin while reducing MED levels, and the benefits of exercise and other important lifestyle choices.
Next Mimms and his team reviewed Cordant’s pharmacy reports, which detailed which patients were at higher risk for abuse and diversion and why, as well as gave him control over the process of helping them to safely and effectively bring down their prescribed opioid levels.
While he did lose some patients who refused changes to their treatment plan, he feels that both his patients and his practice are healthier for the modifications he has implemented.
With today’s opioid crisis escalating, calculating patient risk for abuse and diversion is critical, especially for pain patients taking prescribed opioid medications. One of the ways to calculate risk of overdose that is used by clinicians and regulators is to look at the patient’s MED level.
“Instead of figuring out and remembering what a risky dose is for each and every opioid, all opioids can be converted to an equivalent of one medication – morphine – which allows ease of calculating risk levels,” said Mimms. “For a comparison of opioid doses, a tool was developed to equate the many different opioids into one standard value, similar to how currency can be converted to a standard unit like the dollar. The standard opioid value is based on morphine and its potency, referred to as the morphine equivalent dose.”
Multiple studies have documented the increased risk of unintentional drug overdose as the MED level increases, making the consideration of MED levels extremely important in today’s treatment plans. State regulatory boards and agencies are establishing guidelines for prescribing and dispensing opioids to reduce risks such as misuse and overdose.
“Physicians are in a really hard place right now,” said Mimms. “We need to help our patients who need pain management treatment in order to function and have productive lives, but we know there is a national drug epidemic and that opioids are part of that problem. The only solutions we’re given from outside the industry are more recommendations or regulations. Cordant’s pharmacy is the first real solution I have seen since drug testing became an option
Based in Denver, Cordant Health Solutions™ is at the forefront of combating today’s opioid epidemic through its network of toxicology laboratories and pharmacies. Cordant is committed to providing solutions for payers, clinicians and agencies involved with substance abuse disorder, criminal justice and pain management. Cordant is one of the only healthcare companies that not only offers innovative drug testing options but also includes a full-service, high-touch pharmacy that specializes in complex management and dispensing of controlled substances. Cordant provides testing protocols and digital case-management tools to help clients become more efficient and effective in using toxicology test results.