Outcomes in Patients Discharged from a Primary Care-based Opioid Prescribing Clinic
Prescribing opioids for chronic pain is a challenge for primary care physicians, especially in patients with a past substance use disorder or aberrant medication-related behavior (e.g., using more medication than is prescribed or using another person’s medication). Clinicians at a US Department of Veterans Affairs hospital in Philadelphia set up a pharmacist-run Opioid Renewal Clinic (ORC) to provide ongoing oversight and care to primary care patients who needed additional monitoring. Patients receiving chronic opioid medications who demonstrated aberrant behaviors or were deemed at high risk for a substance use disorder were referred to the clinic. The pharmacist, working in concert with the primary care physician, established patient agreements, adjusted doses, and conducted urine toxicology tests. Medical records of all patients discharged from this service over a 22-month span (86 of the 401 patients referred to the clinic) were reviewed for outcomes 2 years after discharge.
- Fifty-nine percent of those discharged had a history of substance use disorders.
- Recurrent drug use was the most common reason for discharge,* seen in 47% of patients.
- Of those discharged, only 17% received substance abuse treatment during the follow-up period.
The challenge of prescribing controlled substances in primary care, especially to patients with a past substance use disorder and/or aberrant behavior, may be at least partially addressed by specialty programs such as this clinic. Of note, the majority of patients referred to the ORC continued to receive services over the 2-year study period. The high rate of ongoing illicit drug use and the low rate of engagement in substance abuse treatment in those discharged challenges the system to provide appropriate care for those with pain and ongoing substance abuse.David A. Fiellin, MD
Becker WC, Meghani SH, Barth KS, et al. Characteristics and outcomes of patients discharged from the Opioid Renewal Clinic at the Philadelphia VA Medical Center. Am J Addict. 2009;18(2):135–139.