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Better-Educated Clinicians Can Decrease Opioid Misuse, Study Finds

This article is more than 8 years old.

As government officials brainstorm ways to curb the country's growing opioid epidemic, one Boston-based program combats misuse, abuse and overdose by educating clinicians on how to safely prescribe painkillers to patients.

Opioid-related overdose deaths have increased in the United States, according to numbers provided by the Centers for Disease Control and Prevention (CDC). There were 16,235 deaths involving prescription opioids in 2013, an increase of 1% from 2012.

Published in Pain Medicine, a new study, conducted by Boston University School of Medicine (BUSM), revealed that clinicians who complete continuing education classes make more informed decisions about initiating, continuing, changing or discontinuing opioids to their patients.

A report released in June 2015 revealed that only 25% of physicians who are certified to prescribe opioids believe they are “very confident” in their skills to manage patients using these drugs.

"Proper education focuses on the clinical complexities of chronic pain and opioid prescribing," said Dr. Daniel Alford, associate professor of medicine and assistant dean at Boston University School of Medicine and course director of the SCOPE of Pain program, in an interview. "Clinicians should understand the limitations and the risks of opioid prescribing, how to assess and mitigate those risks and be competent in discussing these limitations and risks with patients (and their families)."

He added: "In essence it is not dissimilar from other things clinicians do, that is, for any treatment for any chronic problem clinicians balance the potential benefits and risks and discuss these with patients before coming up with a treatment plan."

Researchers used BUSM's Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program, which was launched in 2013, for the study. Since its inception through June 2014, SCOPE of Pain has passed 10,566 participants. More than 25% of them were considered the primary target group.

After completing the program, 87% of respondents stated that they were planning to make at least one change in their practice to meet guideline-based care. The most frequently stated changes, according to the report: improve opioid prescribing documentation, implement or improve opioid prescribing patient education or communication and institute or improve patient-prescriber agreements.

"In some ways we are empowering clinicians to make good clinical decisions regarding opioid prescribing for chronic pain by individualizing care for each patient based on that patient's chronic pain issues and opioid misuse risk," Alford said.

Approximately 66.8% reported increased confidence in guideline-based opioid prescribing practices after only two months after the training.

"Our experience is that most prescribers do want to become better educated in opioids and in pain management in general," Alford said. "I believe this is the case because chronic pain is common and accounts for up to 20% of primary care visits and chronic pain management if poorly covered at all levels of clinician training."

He continued: "I also believe there is fear around opioid prescribing based on all the reports in the lay press and concern that clinicians may be part of the problem by overprescribing."

"While we showed changes in clinician-level outcomes (confidence, practices changes), ultimately we would like to measure changes in patients-level and population-level outcomes including improved pain management, decreased prescription opioid overdoses and addiction, for example," he said.