Opioid Safety: Complex Pain Case Conferences

The 2016 CDC guidelines and the 2017 Veterans Administration and the Department of Defense (VA/DoD) chronic pain guidelines discouraged the use of chronic opioid therapy for non-cancer, or non-palliative care pain. Both assert that chronic opioid use could cause potential adverse events such as depression, addiction, and death. Both encourage non-opioid interventions such as cognitive behavioral therapy, physical therapy, and various other modalities. To better manage opioid patients with chronic pain, Walter Reed Internal Medicine Department convened a multidisciplinary group composed of pharmacists, physical therapists, psychologists, social workers, internists, and addiction specialists. The group reviewed one patient monthly. Research question: what impact can a multidisciplinary team have on opioid prescribing? STUDY DESIGN: Small cohort study. A clinician performed a chart review of the patients discussed in the multi-disciplinary group. The opioid medications were converted into morphine equivalent daily doses (MEDD) and graphed per patient over time. Although there were 12 patients total, one did not use opioids, and another had not had a follow-up. Among the ten patients left, six had a decrease in their MEDD, three patients’ MEDDs remained the same, one Patient's MEDD increased. The success in lowering 6 of 10 MEDDs is likely multifactorial and based on access to a wide variety of providers and on continuity of care despite being in an institution where turnover is high due to the abundance of military providers. There was a 60% reduction in opioid utilization. In addition, there were unexpected benefits of improved continuity of care, and access to care. Although this a small study, the results demonstrate that a multi-disciplinary approach to managing pain is able to improve healthcare quality, patient safety, and help reduce reliance on opioids. We see opportunities for larger studies as our program matures.