Table 2.

Key Components of Opioid Risk Reduction Initiatives and Selected Measures of Adherence to Risk Reduction Initiatives

SourceIntervention ClinicsControl Clinics
Washington State COT Guideline (enacted as law in March 2010)18
Check appropriateness of pain treatmentXX
Screen for drug abuse and diversionXX
Group Health Opioid Risk Reduction Initiatives18,20,50
Decrease COT dose (intervention clinic dose decreased from 74 mg MED to 46 mg MED versus control clinic decrease from 89 mg MED to 74 mg MED)X
Online CME followed by 1-hour discussion in each intervention clinic (87% of primary care providers participated)X
Medical staff leader advocacyX
Designated physician to manage COT and expert consultation for physicians in each primary care clinicX
Practice education tools (eg, patient education materials, care plan template, online calculator to estimate MED)X
COT care plans documented in the EHR and financial incentive for completing the plans (documented care plans increased from 10% to over 80% over the course of the intervention)X
Guideline-based monitoring visits and urine drug screening (urine drug screening increased from less than 15% in both intervention and control clinics to about 50% in the intervention clinics and less than 20% in the control clinics)X
28-day-maximum opioid prescription and 5-day refill noticeX
  • COT, chronic opioid therapy; MED, morphine equvalent dose; CME, continuing medical education; EHR, electronic health record; X, component was used in these clinics.