Improving Assessment of Opioid Use Disorder (OUD) for People with Disabilities and Chronic Arthritis Pain
Every day, 46 people die from overdoses involving prescription opioids in the United States. Increased oversight of physician prescribing practices, especially for long-term management of chronic noncancer pain, has helped curb overprescribing. However, some advocates fear that patients who need and use prescription opioids as prescribed for chronic pain may be kept from accessing medications that improve their quality of life.
Musculoskeletal conditions such as arthritis are the leading cause of disability and chronic pain in the United States. About 54.4 million U.S. adults live with arthritis, with 8.4 million reporting their condition as disabling. Historically, clinicians have prescribed opioids to people experiencing severe and chronic arthritis pain with the goal of improving physical function, participation in daily activities, and quality of life. Although opioids can control acute pain effectively, there is insufficient evidence about the effectiveness of long-term use of opioids to control chronic pain among people with and without disabilities, and whether the potential risks, including developing an OUD, outweigh the benefits.
Through a National Institute on Disability, Independent Living, and Rehabilitation Research grant, AIR is laying the groundwork for primary care clinicians and specialists to accurately assess for OUD in people with disabilities who are taking opioids long term to manage musculoskeletal pain. The objective is to use the best available evidence to help clinicians minimize over- and under-diagnosis of OUD. The project includes:
- Conducting a systematic literature review to identify evidence-based best OUD assessment practices, tools, and resources;
- Identifying barriers and facilitators to OUD assessment and treatment access through qualitative research;
- Adapting and testing a screening tool to detect OUD in people taking opioids long term to manage musculoskeletal pain; and
- Developing and disseminating an OUD assessment and referral toolkit through provider and disability organizations and those training providers in addiction medicine.
Introducing Resources for People with Disabilities and Providers to More Safely Manage Chronic Pain with Opioids (November 2020, PDF)
This brief introduces Partnering for Safer Opioid Use: A Knowledge Hub for People with Disability and their Providers an online resource hub to help providers and people with disability overcome challenges associated with managing chronic pain and the risks associated with opioid use. Evidence-informed resources in the knowledge hub are tailored to meet the information needs of each intended audience. These resources help providers and people with disability work together to:
- Create a chronic management plan, that may include opioids;
- More safely manage opioid use;
- Promptly and correctly identify opioid use disorder, should it occur;
- Use a screening tool to assess opioid use disorder;
- Select opioid use disorder services responsive to the needs of a person with disability who lives with chronic pain; and
- Coordinate care once opioid use disorder is diagnosed.
The brief also includes recommendations for use of a tool to screen for opioid misuse in people with disabilities. The AIR team tested the Current Opioid Misuse Measure (COMM™) to look at the unique situations of people with disability from degenerative joint disease.
What I Want My Doctor to Know About How Arthritis and Chronic Pain Affect My Everyday Life (September 2019, PDF)
Based on interviews with people with a disability from arthritis who are taking prescription opioids long term or who stopped taking opioids after developing an OUD, this brief describes how people want doctors to:
- Talk with them in detail about how they can treat chronic pain and improve function;
- Treat the whole person, thinking beyond their health condition;
- Describe next steps if medication does not control their pain or improve function;
- Explain the signs and symptoms of OUD and the treatment plan if they develop OUD; and
- Outline other options for managing pain if they develop OUD and cannot take opioids anymore.
Assessing and Monitoring Long-Term Opioid Use for People With Chronic and Disabling Arthritis Pain (June 2019, PDF)
This brief summarizes existing research on OUD and long-term opioid use by people with chronic noncancer pain. The following approaches build on best practices for assessing OUD risks and monitoring for OUD among people with disabilities from arthritis using opioids long term:
- Clinicians and patients with disabilities from arthritis need to establish a collaborative relationship, including shared decision making about opioid use and monitoring.
- Providers can partner more effectively with patients when they are aware of biases they bring to the relationship.
- Patients need access to evidence-based and relevant information to be partners in their care.
- Patients need to understand the importance of not relying solely on opioids to manage chronic pain, and they should know how to proactively manage factors in their lives that affect their pain experience.