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Utah Opioid Prescribing Guidelines: Preventing Overdoses

Learn about the origin and process of the Utah Guidelines developed by Anna Fondario, MPH, from the Utah Department of Health's Violence and Injury Prevention Program. These guidelines aim to address the rise in fatalities linked to pain pills. Understand the Prescription Pain Medication Management and Education Program, including research, prescribing guidelines, and collaborative efforts. Explore the Utah Clinical Guidelines on Prescribing Opioids, their purpose, and the expert panels involved in their development. Discover the dissemination methods, physician education objectives, and evaluation strategies to enhance safe opioid prescribing practices in Utah.

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Utah Opioid Prescribing Guidelines: Preventing Overdoses

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  1. Origin and Processof Utah Guidelines Anna Fondario, MPH Utah Department of Health Violence and InjuryPreventionProgram

  2. Fatalities linked to pain pills on the rise January 21, 2005 Legal drugs: Deadly overdoses up dramatically among Utah residents; Drug deaths on the rise across Utah “This was a horrendous problem… a whole lot of people who died shouldn’t have died.” --Dr. Todd Grey, Utah Chief Medical Examiner

  3. The Bottom Line • In 2006, six people were dying per week in Utah from legal prescriptions, mostly long-acting opioids. • Two people died per week of an opioid prescribed legally within the preceding month. • Prescription opioid deaths outnumbered motor vehicle crash deaths in 2007.

  4. Prescription Pain Medication Management and Education Program • Research • Causes, risk factors, solutions • Prescribing Guidelines • “medical treatment and quality care guidelines that are scientifically based; and peer reviewed” • Educate • Health care providers, patients, insurers, public

  5. Collaboration • Steering Committee • Meets monthly • Advisory Committee • Open to all interested parties & stakeholders • Meets quarterly • Work Groups • Patient and Community Education • Policy, Insurance, Incentives • Data, Research, Evaluation

  6. Utah Clinical Guidelines on Prescribing Opioids • Scope • For primary care and specialty physicians in the state of Utah for guidance on prescribing opioids for both acute and chronic pain • Target Audience • Clinicians who prescribe opioids in their practice

  7. Guidelines: Purpose • To provide recommendations that balance the benefits of use against the risks to the individual and society. • To provide useful tools to practitioners.

  8. Steering Committee • Developed • Key questions • Scope • Inclusion criteria used to guide the evidence review process • Extensive review of existing guidelines

  9. Grading of Evidence and Recommendations • Evaluation and inclusion criteria • Published after 1999 • Disclosure of funding • Scored on process • Evidence-based vs. consensus • 4 sets received scores <8 • Reviewed by 3 public health professionals

  10. Expert Panels • Guidelines Recommendation Panel • Formulated recommendations based on the evidence-based guidelines • Implementation and Tool Panel • Reviewed recommendations to ensure feasibility of implementation • Determined tools for inclusion in guidelines

  11. Guideline Recommendation Development Process • First meeting • High-scoring guidelines distributed • Review for commonalities • Second meeting • Additional guidelines • Wiki

  12. Guideline Recommendation Development Process • Third meeting • Straw poll • Fourth meeting • Final discussions

  13. Tools Development Process • Tool workbook • Scoring • Elimination • Discussion

  14. Open Comment Period • 45 days • Resulted in > 80 comments • Public Concerns • Introducing barriers • Impact of addiction • Clinicians • Overall supportive

  15. Dissemination • Online / Print (mail / postcards) • Trainings / Conferences • Emails • Advertisement • Utah Medical Association • Intermountain Health Care • Utah Hospital Association • Utah Medical Insurance Association • Utah Academy of Physician Assistants • Utah Pharmacy Association

  16. HealthInsight • Physician education • Small group trainings • Up to 20 CME’s (follow up surveys) • 6 to 10 doctors • Required homework • Evaluation of behavior change • Large group presentations • ~ 5 CME’s • Mass mailings

  17. Content Delivery Methods • Education teams • Session content • Data • Guidelines • Resource tool box • CSD tutorial • Referral options • Follow-up

  18. Physician Education Objectives • Increase safety of opioid prescribing via adoption of the guidelines • After presentation, doctors will be able to... • Implement “Six practices for safe opioid prescribing” • Identify tools to help physicians integrate these practices into their work • Assess improvement in prescribing patterns in the first month and at six months

  19. Evaluation • System level changes such as inclusion of screening tools into electronic medical records will be needed to improve compliance with the Guidelines.

  20. Evaluation

  21. Questions

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