Statewide cross-sectional survey of emergency departments' adoption and implementation of the Ohio opioid prescribing guidelines and opioid prescribing practices

The state of the science in opioid policy research

OBJECTIVE

Characterize the state of the science in opioid policy research based on a literature review of opioid policy studies.

METHODS

We conducted a scoping review of studies evaluating the impact of U.S. state-level and federal-level policies on opioid-related outcomes published in 2005-2018. We characterized: 1) state and federal policies evaluated, 2) opioid-related outcomes examined, and 3) study design and analytic methods (summarized overall and by policy category).

RESULTS

In total, 145 studies were reviewed (79 % state-level policies, 21 % federal-level policies) and classified with respect to 8 distinct policy categories and 7 outcome categories. The majority of studies evaluated policies related to prescription opioids (prescription drug monitoring programs (PDMPs), opioid prescribing policies, federal regulation of prescription opioids, pain clinic laws) and considered policy impacts with respect to proximal outcomes (e.g., opioid prescribing behaviors). In total, only 29 (20 % of studies) met each of three key criteria for rigorous design: analysis of longitudinal data with a comparison group design, adjustment for difference between policy-enacting and comparison states, and adjustment for potentially confounding co-occurring policies. These more rigorous studies were predominately published in 2017-2018 and primarily evaluated PDMPs, marijuana laws, treatment-related policies, and overdose prevention policies.

CONCLUSIONS

Our results indicated that study design rigor varied notably across policy categories, highlighting the need for broader adoption of rigorous methods in the opioid policy field. More evaluation studies are needed regarding overdose prevention policies and policies related to treatment access. Greater examination of distal outcomes and potential unintended consequences are also warranted.

Addressing the Opioid Crisis through an Interdisciplinary Task Force in Cincinnati, Ohio, USA

Opioid use has been a topic of concern in recent years in the United States, causing thousands of deaths each year. Ohio is one of the states hit hardest by the epidemic, and its state and local governments have responded with comprehensive health policies. Cincinnati, located in the southwest region of Ohio, is one of the epicenters of the state’s opioid crisis. Responding to the needs of their community, the University of Cincinnati (UC) and its affiliate health system, UC Health, have brought together leaders in research, clinical practice, and education to form the UC/UC Health Opioid Task Force. By encouraging interdisciplinary partnerships, the Task Force is pioneering new ways to understand, prevent, and treat opioid use disorder, while preparing the next generation of healthcare professionals. Additionally, collaboration across departments in UC Health has improved access to treatment and recovery resources for hundreds of patients. Leading educational events, supporting local agencies, and participating in government initiatives have further solidified UC and UC Health’s role as a stakeholder in this crisis, showcasing how academic health centers are critical to promoting public health.

Effectiveness of interventions on the appropriate use of opioids for noncancer pain among hospital inpatients: A systematic review

AIMS

To summarise the effectiveness of interventions on appropriate opioid use for noncancer pain among hospital inpatients.

METHODS

Two reviewers independently searched 6 databases up to March 2018 original research articles reporting on quantitative outcomes of interventions on appropriate opioid use among hospital inpatients. Appropriate opioid use was measured by changes in prescribing, such as the lowest effective opioid dose and duration, or clinical outcomes such as adequate pain control. Quality and intervention complexity assessments were performed by 2 independent reviewers. The full methodological approach was published on PROSPERO (ID: CRD42019145947).

RESULTS

Of 398 full-text articles assessed for eligibility, 37 articles were included in the review. Most articles had a moderate or high risk of bias (27 of 37 studies). Thirty-one articles primarily addressed appropriate opioid use and 6 articles targeted opioid safety as a secondary outcome. A multifaceted approach was the most common primary intervention (16 studies) and adequate pain control was the main outcome measured (14 studies). Health provider education, reinforced by hard-copy material and feedback, was associated with a 13.0 to 29.5% increase in the proportion of opioid prescriptions written in concordance with local guidelines and reduced pain scores ranging from 7.0 to 34.5%. Interventions to improve opioid safety in patient-controlled analgesia reduced medication errors by up to 89.1%.

CONCLUSION

Interventions involving academic detailing and education, especially when reinforced by feedback, show positive effects on appropriate opioid use among hospital inpatients. Future studies investigating the impact of administrative interventions on opioid use and related outcomes are warranted.