BMC to implement and evaluate opioid risk reduction model in primary care settings

Researchers at Boston Medical Center (BMC) have received a $2.67 million grant from the National Institute on Drug Abuse (NIDA) to implement and evaluate a new model of care in primary care settings aimed at decreasing the misuse of and addiction to opioids among patients with chronic pain. Karen Lasser, MD, MPH, and Jane Liebschutz, MD, MPH, both physicians in general internal medicine at BMC and associate professors of medicine at Boston University School of Medicine, will serve as principal investigators.

According to the Institute of Addiction Medicine, the misuse of opioid prescription painkillers increased by 140 percent between 1992 and 2003 and is a significant public health problem. While primary care providers (PCPs) are the leading prescribers of opioids for chronic pain, few providers follow standard practice guidelines to assess and monitor the patient's chronic pain treatment.

Implementing Opioid Risk Reduction Strategies into Primary Care Practice is a five-year project including a randomized trial that will be implemented at four federally qualified health centers (FQHC) in the Boston area. The investigators will follow patients and providers for 12 months after the intervention has been implemented and will evaluate how PCPs adhered to the chronic opioid therapy guidelines. They also will monitor the rates of opioid misuse among patients.

The suggested system changes include a nurse-managed registry to plan individual and population-based care; tools in the electronic medical record that will prompt clinicians to order urine drug tests and facilitate screening for substance abuse and depression; and visits from trained individuals to provide the providers with assistance as they implement the changes into their practice. These changes are aimed at improving providers' monitoring of patients on chronic opioid therapy.

The investigators will evaluate the implementation strategies in order to integrate the best evidence-based strategy to successfully manage patients receiving opioid therapy to manage chronic pain in a primary care setting.

"We are conducting this study at community health centers (CHCs) because they could become a model for improved care at other CHCs as their roles expand under the Affordable Care Act," said Lasser and Liebschutz.