Addressing Opioid Misuse and Safer Prescribing Practices

Opioid misuse by uninformed patients contributes to the opioid epidemic, a major public health concern in the US, according to healthcare practitioners and government agencies. Numbers linked to the epidemic are staggering: 25% of patients on long-term opioid therapy are struggling with addiction, and prescriptions have increased by 300% since 1999.

OpioidIQ, a resource developed by Collegium Pharmaceutical, “aims to bring awareness to [this] under-recognized issue by helping [healthcare practitioners] identify unintentional misuse, enhance patient communication, and optimize treatment management.” The site features videos of Jeffrey Gudin, MD, director, pain and palliative care, Englewood Hospital and Medical Center, New Jersey who also helped launch the website on September 6, 2016 at PAINWeek 2016. 

On the website, several aspects of the issue are addressed through short informative videos as well as guidelines, fact sheets, brochures and a conversation starter. Users can navigate the site and efficiently get information on how to determine appropriate use and unintentional misuse of opioids, and also get tools to adequately communicate and empower their patients.

Based on available evidence and guidelines, Dr Gudin recommends that healthcare practitioners use a “stepwise approach” when first designing a treatment plan for patients with chronic pain; in particular, non-opioid analgesics (eg, acetaminophen, over-the-counter and anti-inflammatory medications), as well as behavioral and complementary therapies should initially be considered.^1,2

Deciding between prescribing immediate- and extended-release opioids will require healthcare practitioners to inquire about the temporal nature of the patient’s pain. In addition, clinicians are advised to make use of urine drug screening and prescription drug monitoring programs, and determine whether their patients alter the mode of opioid delivery (eg, by chewing, crushing or grinding the pills).

In addition, healthcare practitioners need to be cognizant of mechanisms of action of the different types of abuse-deterrent formulations available (eg, combinations of µ-opioid agonist and antagonist; formulations containing a substance producing unpleasant effects at high dosage; those with alteration-proof physical or chemical barriers; those crossing the blood-brain-barrier at a slower rate).

In an interview with Clinical Pain Advisor, Barry Duke, Chief Commercial Officer at Collegium Pharmaceutical, stressed that one of the missions of the company was to advocate for responsible opioid prescribing. This brought Collegium to consult with key opinion leaders, who highlighted a need for additional educational resources to allow HCPs to prescribe opioids with more confidence.

They also noticed widespread fear among prescribers regarding the opioid epidemic. According to Mr Duke, the “short vignettes” featured on OpioidIQ “give physicians an easy way to learn about different issues around misuse.”

Collegium Pharmaceutical has 1 approved product built around the DETERx^® abuse-deterrent technology that provides extended-release drug delivery; the company has additional products in its pipeline based on this technology. 

References

1. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016. MMWR Recomm Rep. 2016;65(1):1-49.
2. Manchikanti L, Abdi S, Atluri S, et al. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part 2–guidance. Pain Physician. 2012;15(3 Suppl):S67-116.

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This article originally appeared on Clinical Pain Advisor