Clearer Guidelines Needed for Patients’ Self-Managing Opioid Prescriptions

The opioid crisis is among the top concerns related to health care reform. Researchers at the American Academy of Pain Medicine’s 2019 Annual Meeting presented statistics that while concern is extremely justified, there are critical gaps in education, evidence, and practice in the management of prescription opioid use. 

Authors, Salimah H. Meghani, PhD, MBE, FAAN, University of Pennsylvania, and colleagues presented, “Despite unprecedented national attention on safe opioid prescribing, little is known about the other side of the coin, that is, how patients take prescribed opioids and potential risks that can stem from opioid use patterns.”

The multimethod study investigated opioid self-management practices reported by cancer outpatients receiving active cancer treatments via freelisting analysis and in-depth qualitative interviews. Dr Meghani and colleagues pointed out that this is a group excluded from the scope of the Centers for Disease Control and Prevention opioid guidelines for pain. The patients, mean 56 years old, included in the study were institutionally approved by the University of Pennsylvania from an outpatient oncology center.

The analysis found, “Patients [>50% with metastatic disease] described not receiving clear education from their prescribers about how best to manage their opioids.” The researchers reported patients commenting, “Once I self-taught myself and learned how to manage the pain…it made such a difference,” further demonstrating that self-management education and guidelines are crucial.

According to results of the study, self-management of opioid prescriptions can include patients teaching themselves and developing regimes which involves altering dosage, frequency, halting treatment all together, and altering timeframe of use.  

“Patients described wanting to stick to a manageable formula of medicines that ‘work well together,’ delay the use of ‘hard medicines,’ avoid being labeled a ‘pill-taker,’ minimize side effects, and use treatments that would not destroy the immune system,” explained the researchers. 

Dr Meghani and colleagues concluded, “The Department of Health and Human Services Pain Management Taskforce has identified self-management as one of the best practices in improving pain and the safety of prescribed opioids. In the context of the opioid crisis and recent
discrepancies in cancer pain guidelines, there is an urgent need to clarify what comprises best practices in opioid self-management and translate the evidence into practice and patient education interventions.”—Edan Stanley