Controlled Substance Agreements for Opioids in a Primary Care Practice

• Published in: Journal of pharmaceutical policy and practice Vol. 10; no. 1; p. 29
• Main Authors: Philpot, Lindsey M, Ramar, Priya, Elrashidi, Muhamad Y, Mwangi, Raphael, North, Frederick, Ebbert, Jon O
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 12.09.2017; BioMed Central; Taylor & Francis Group
• Subjects: Alcohol; Analysis; Anxiety; Clinical medicine; Comorbidity; Controlled substances; Data collection; Dosage and administration; Drug dosages; Drug testing; Enrollments; Medicine; Mental depression; Narcotics; Nursing; Opioids; Pain management; Patients; Physicians; Prescription drugs; Prescription writing; Primary care; Primary health care; Safety and security measures; Studies; Urine
• ISSN: 2052-3211; 2052-3211
• DOI: 10.1186/s40545-017-0119-5

Opioids are widely prescribed for chronic non cancer pain (CNCP). Controlled substance agreements (CSAs) are intended to increase adherence and mitigate risk with opioid prescribing. We evaluated the demographic characteristics of and opioid dosing for patients with CNCP enrolled in CSAs in a primary care practice. We conducted a retrospective cohort study of 1066 patients enrolled in CSAs between May 9, 2013 and August 15, 2016 for CNCP in a Midwest primary care practice. Patients were prescribed an average of 40.8 (SD ± 57.0) morphine milligram equivalents per day (MME/day), and 21.5% of patients were receiving ≥50 MME/day and 9.7% were receiving ≥90 MME/day. Patients who were younger in age (≥ 65 vs. < 65 years,  < 0.0001), male gender (  = 0.0001), and used tobacco (  = 0.0002) received significantly higher MME/day. Patients with more co-morbidities (Charlson Comorbidity Index, CCI) received higher MME/day (CCI > 3 vs. CCI ≤ 3,  = 0.03), and reported higher average pain (CCI > 3 mean 5.8 [SD ± 2.1] vs. CCI ≤ 3 mean 5.3 [SD ± 2.0], = 0.0011). Patients on an identified tapering plan (6.9%) had higher MME/day than patients not on a tapering plan (  = 0.0002). CSAs present an opportunity to engage patients taking higher doses of opioids in discussions about opioid safety, appropriate dosing and tapering. CSAs could be leveraged to develop a population health management approach to the care of patients with CNCP.