Fort Bragg: Risk Mitigation in Chronic Opioid Therapy for Pain
Abstract
Background: Millions of people suffer from chronic non-cancer pain (CNCP). Many of those patients receive chronic opioid therapy. In the military, the risk of chronic pain increases due to service-related injuries. To address the safety concerns related to opioid use, the VA/DoD published an evidence-based Clinical Practice Guideline (CPG) on the management of chronic pain and safe opioid prescribing practices. The use of risk mitigation strategies decreases the adverse outcomes related to chronic opioid use, including opioid misuse, abuse, respiratory depression, and death. Purpose: To review the use of risk mitigation strategies for patients on chronic opioid therapy for pain in primary care at Fort Bragg and compare it to the 2017 VA/DoD Chronic Opioid Therapy for Pain CPG. Project Design: A review of the literature focused on articles addressing clinical guidelines for CNCP, opioid therapy, and risk mitigation, including articles cited in the CPG. Articles were evaluated for rigor and recommendations for the risk mitigation strategies of UDT, co-prescription of naloxone, and co-prescription of benzodiazepines were compared. A retrospective chart review of patients currently on opioid therapy for CNCP assessed the use of UDT, naloxone, and benzodiazepine co-prescription. The results of the chart review were compared to both the CPG recommendations and the findings of the literature review. Organizational Impact/Implications for Practice: Review of more recent literature supports the CPG recommendations. Results of chart review demonstrate that risk mitigation strategies were more consistently evident within the military treatment facility when compared to care received in the civilian network. Benzodiazepine co-prescription with opioids was low. Over 75 percent of patients received naloxone prescription consistent with guidelines. Use of UDT was inconsistent, which is partially attributable to vague guidelines.
Document Details
- Document Type
- Technical Report
- Publication Date
- Apr 17, 2019
- Accession Number
- AD1127788
Entities
People
- Lisa A. Bowers
Organizations
- Uniformed Services University of the Health Sciences