For health plans and providers, managing patients on opioids requires a delicate balance between the patient’s pain management needs and the risk of opioid misuse.
We asked our clinical experts to highlight their biggest challenges to improving care for patients on opioids, and their answers reflect the changing pain management and addiction landscape.
1. Lack of proper skillset to treat pain. Providers with little training have been asked or felt pressure to treat pain, leading to dangerous opioid prescribing patterns.
2. Balancing new opioid restrictions with a specific pain condition. A patient’s pain may have been under control while on a higher dose of opioids, but new restrictions require the patient’s dose be reduced before available measures are taken to improve their condition in the long-term.
3. Tapering patients. One of the biggest challenges is getting patient buy-in for opioid tapering when they’ve been on opioids for years and believe the medications have been working for them. Tapering must also be tailored to the patient. Tapering a patient on high-dose opioids too quickly can lead to withdrawals and hospital admission.
4. Clinician discernment & the subjective nature of pain. Clinicians must take subjective information on the patient’s pain levels into account along with objective information to determine when opioids are warranted.
5. Risk of addiction. Patients on high dose or long duration opioids, with behavioral health conditions, or an existing substance use disorder are at increased risk of opioid addiction. Providers must regularly evaluate the risks and benefits of continuing opioid therapy for these patients.
We help our health plan clients navigate these challenges by offering their providers a comprehensive view of a patient’s medical history and alerting to risk related to opioid use, including dangerous polydrug combinations, ED visits for overdose, and patients in need of screening for opioid use disorder. Struggling to safely and effectively manage your members on opioids? Let’s find some time to talk.