How Much of an Impact Do the CDC Opioid Prescribing Guidelines Have on Patient Risk?

April 23, 2019

In response to an opioid crisis that had reached full epidemic status by 2016, the Centers for Disease Control and Prevention published a set of guidelines for hospitals, health systems, and physicians to follow when prescribing prescription opioids.

While nonbinding, these suggestions were adopted by many states across the country looking to tackle the opioid epidemic in a more cohesive manner. Since then, the question has remained: Are these guidelines effective in reducing patient risk?

A Mix of Success from the Guidelines

Across the board, federal and state guidelines generally have adopted five main steps for physicians needing to assess the risk of substance abuse in a patient. These steps have been adopted by many organizations across the country, including the Centers for Medicare and Medicaid Services and the Federation of State Medical Boards:

1. Risk Assessment: These are assessment tools that doctors and patients work to fill out, but their similarities to personality assessments with vague questions and broad answers often make it easy for a patient dedicated to getting more pills to give results that minimize actual risk.
   
2. Treatment Agreement: The second step is getting the patient to sign an agreement form that is supposed to bind the patient into not abusing the prescription that they are looking for. These agreements are great for getting patients in the right frame of mind, but they do little to hold back patients who are already addicted or looking to abuse the system.
   
3. PDMP Check: PDMP checks are the first guideline that allows physicians to have hard evidence of a patient’s risk for opioid abuse. These databases are very useful for keeping tabs on what medications a patient might have been prescribed elsewhere, but they’re not always perfect. Studies show that PDMP results show a 4% aberrancy rate, so there’s still a need for more.
   
4. Drug Test: The only way for physicians to know exactly what their patients currently have in their systems is a drug test. Combined with a PDMP check, these are the two most effective tools for accurately describing a patient’s current opioid risk. The other guidelines are useful to a point but can be manipulated by a patient looking to abuse opioids.
   
5. Pill Counts: The final guideline for physicians is to order intermittent pill counts for patients they deem high enough risk. This guideline is good in faith, but it already sends pills out the door that might never be accounted for after that.
   

So why are PDMP checks and drug tests so underutilized if they’re the most effective way to assess patient risk? One, because they’re time-consuming from the physician’s point of view. Drug tests are not immediate responses and even after the results come back, it can be difficult to consult the PDMP to find all the information needed to assess the risk.

The second reason is that there is no proof that patient monitoring with PDMP checks and drug tests causes a decrease in risk for abuse. The CDC guidelines are new enough that up until recently, there hasn’t been a study done to follow patient opioid abuse risk through a round of monitoring by the CDC guidelines.

This exact topic is what Gina Cooper of Community Health Network and Scott LaNeve of hc1.com will be covering at this year’s Executive War College. Together they will be setting the stage for what our current guideline systems enforce and what kind of effect they can have on patients over time. Mark your calendars for this presentation to learn more about how the CDC’s Opioid Management Guidelines can have an effect on a patient’s risk score over time.

Understanding the Opioid Epidemic: Size of the Problem, Challenging Requirements for Patient Management, and Ways for Labs to Add Value to Physicians, Payers, and Patients

Where: Sheraton Hotel – New Orleans, LA

When: Tuesday, April 30 – 7:30 AM – 8:20 AM