Pa. groups to build medical home for chronic pain
With research showing a dramatic shift in prescribing patterns that has expanded the scope of opioid substance abuse, the Penn Pain Medicine Center will partner with the University of Pennsylvania School of Medicine’s Center for Substance Abuse Solutions and Department of Internal Medicine to develop a patient-centered medical home care model for patients suffering chronic pain.
The patient-centered medical home process integrates care provided by primary care physicians and specialists in an effort to provide high-quality, comprehensive care. New health IT applications, including EHRs and Internet-based collection of patient outcomes, will be used to improve coordination of care, according to the Penn Pain Medicine Center.
Researchers hope that the medical home model will improve pain care and lower the chances of diversion and abuse of pain medications.
In two reports in the Journal of the American Medical Association, addiction researchers at the University of Pennsylvania School of Medicine in Philadelphia and the National Institute on Drug Abuse recommended a comprehensive effort to reduce public health risks while improving patient care, including better training for prescribers, pain management treatment assessment, personal responsibility and public education.
There has been a drastic increase in opioid prescriptions while prescriptions for non-steroidal anti-inflammatory drugs have dropped, the researchers found. Prescriptions for hydrocodone and oxycodone account for 84.9 percent of opioid prescriptions. During the last 10 years, there has been a fivefold increase in admissions to substance abuse programs for opioid addiction, the report found.
“While effective at reducing pain symptoms, opioid medications such as hydrocodone and oxycodone are associated with high rates of abuse, particularly among young adults. One in four 18-25 year olds will abuse prescription pain killers in their lifetime,” the report noted.
Researchers suggested targeting the relatively high rate of prescriptions issued to adolescents and young adults, who received 11.7 percent of the 202 million opioid prescriptions in the U.S. during 2009. A large share of the prescriptions to young adults was from dentists, and researchers said there is a need for medical professionals to evaluate alternative pain medications in this particularly vulnerable age group.
The research was conducted by The National Institute on Drug Abuse, of the National Institutes of Health.
In another study, Amy S. B. Bohnert, PhD, from the Department of Veterans Affairs, Health Services Research & Development Center of Excellence and Serious Mental Illness Treatment Resource and Evaluation Center, in Ann Arbor, Mich., and colleagues examined the association of maximum prescribed daily opioid dose and dosing schedule (“as needed,” regularly scheduled, or both) with risk of opioid overdose death among patients with cancer, chronic pain, acute pain and substance use disorders and found that among patients receiving opioid prescriptions for pain, higher opioid doses were associated with increased risk of opioid overdose death.
The researchers collected data from 2004 to 2008 at the Veterans Health Administration (VHA) on all unintentional prescription opioid overdose decedents (n = 750) and a random sample of patients (n = 154,684) among those individuals who used medical services in 2004 or 2005 and received opioid therapy for pain.
The frequency of fatal overdose over the study period among individuals treated with opioids was estimated to be 0.04 percent. The risk of overdose death was directly related to the maximum prescribed daily dose of opioid medication, Bohnert and colleagues stated.
The patient-centered medical home process integrates care provided by primary care physicians and specialists in an effort to provide high-quality, comprehensive care. New health IT applications, including EHRs and Internet-based collection of patient outcomes, will be used to improve coordination of care, according to the Penn Pain Medicine Center.
Researchers hope that the medical home model will improve pain care and lower the chances of diversion and abuse of pain medications.
In two reports in the Journal of the American Medical Association, addiction researchers at the University of Pennsylvania School of Medicine in Philadelphia and the National Institute on Drug Abuse recommended a comprehensive effort to reduce public health risks while improving patient care, including better training for prescribers, pain management treatment assessment, personal responsibility and public education.
There has been a drastic increase in opioid prescriptions while prescriptions for non-steroidal anti-inflammatory drugs have dropped, the researchers found. Prescriptions for hydrocodone and oxycodone account for 84.9 percent of opioid prescriptions. During the last 10 years, there has been a fivefold increase in admissions to substance abuse programs for opioid addiction, the report found.
“While effective at reducing pain symptoms, opioid medications such as hydrocodone and oxycodone are associated with high rates of abuse, particularly among young adults. One in four 18-25 year olds will abuse prescription pain killers in their lifetime,” the report noted.
Researchers suggested targeting the relatively high rate of prescriptions issued to adolescents and young adults, who received 11.7 percent of the 202 million opioid prescriptions in the U.S. during 2009. A large share of the prescriptions to young adults was from dentists, and researchers said there is a need for medical professionals to evaluate alternative pain medications in this particularly vulnerable age group.
The research was conducted by The National Institute on Drug Abuse, of the National Institutes of Health.
In another study, Amy S. B. Bohnert, PhD, from the Department of Veterans Affairs, Health Services Research & Development Center of Excellence and Serious Mental Illness Treatment Resource and Evaluation Center, in Ann Arbor, Mich., and colleagues examined the association of maximum prescribed daily opioid dose and dosing schedule (“as needed,” regularly scheduled, or both) with risk of opioid overdose death among patients with cancer, chronic pain, acute pain and substance use disorders and found that among patients receiving opioid prescriptions for pain, higher opioid doses were associated with increased risk of opioid overdose death.
The researchers collected data from 2004 to 2008 at the Veterans Health Administration (VHA) on all unintentional prescription opioid overdose decedents (n = 750) and a random sample of patients (n = 154,684) among those individuals who used medical services in 2004 or 2005 and received opioid therapy for pain.
The frequency of fatal overdose over the study period among individuals treated with opioids was estimated to be 0.04 percent. The risk of overdose death was directly related to the maximum prescribed daily dose of opioid medication, Bohnert and colleagues stated.