An Interdisciplinary Approach to Reducing Opioid Prescriptions to Patients with Chronic Pain in a Spinal Cord Injury Center

Abstract Background The increasing use of prescription opioids has contributed to the epidemic of opioid abuse in the United States. Efforts to reduce opioid prescriptions and offer alternatives for pain management are needed. Objective To determine the success of a multidisciplinary project to manage chronic pain while reducing reliance on opioids in a population of patients with spinal cord injury. Design Retrospective analysis. Setting This study was conducted in an SCI system of care in northeast Ohio. Participants Individuals with spinal cord injury (SCI) receiving outpatient care were included. Interventions Clinicians in SCI and pain management specialties developed a plan to manage individuals with spinal cord injury, particularly for individuals using opioids, including physical, occupational, recreational, and vocational therapy. These services worked closely with the SCI physicians when chronic pain was identified to help better medically manage their pathology and support efforts to decrease opioid use in a multipronged approach. Main Outcomes The primary outcome measures from opioid prescription data from 2008 to 2016 were the percent of outpatients receiving opioids, opioid prescription rates, and opioid prescription doses over time. Results The percent of outpatients receiving opioids and the number of opioid prescriptions through the outpatient service significantly decreased, from 39% to 16% and from 2.5 to 1.5 prescriptions per patient per quarter, respectively, correlating with the introduction of the multidisciplinary interventions. The total morphine equivalent quantities of prescription medications, particularly non-methadone opioids, also decreased significantly. Conclusions The multidisciplinary interventional approach was associated with marked decreases in the percent of patients receiving opioids and the amounts of opioids being prescribed. This reduction could have a significant impact on the opioid crisis. Level of Evidence III