Each day in the United States, 46 people die from overdoses involving prescription opioids, signifying a dramatic increase over the last two decades. The rapid growth in opioid overdoses has put a spotlight on prescribing patterns, with increased pressure on clinicians to reduce opioid prescribing, especially for long-term management of chronic, noncancer pain. Increased oversight and dissemination of opioid prescribing guidelines have begun to curb overprescribing. However, advocates fear the increased scrutiny prevents people who use prescription opioids as prescribed for chronic pain control from accessing these 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. 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, the evidence is insufficient about the effectiveness of long-term use of opioids to control chronic pain among people with and without disabilities, and whether the potential risks outweigh the benefits. Additionally, most research broadly reports on people with chronic, noncancer pain rather than specific subgroups and conditions such as people with arthritis pain.
As part of a grant provided by National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), AIR is working to lay the groundwork for primary care providers and specialists to accurately assess for opioid use disorder (OUD) in people with disabilities who are taking opioids long term to manage musculoskeletal pain, while using the best evidence to minimize OUD over- and under-diagnosis.
The objectives of this project are to:
- Conduct a systematic literature review to identify evidence-based best OUD assessment practices, tools, and resources;
- Identify barriers and facilitators to OUD assessment and treatment access through qualitative research;
- Adapt and test a screening tool to detect OUD in people who take opioids long term to manage musculoskeletal pain; and
- Develop an OUD assessment and referral toolkit and disseminate it through provider and disability organizations and those training providers in addiction medicine.
The outcomes of this project are increased understanding of opioid misuse versus appropriate use in the target population, increased provider knowledge of steps to accurately assess for OUD, strategies for OUD risk stratification, and ways to facilitate transition into OUD treatment.