1. The Problem
In 2005 this patient went in for surgery to correct a deviated septum. The surgery was successful and he was discharged home with a prescription for 30 Percocet tablets. His recovery was uneventful and when he went back for a re-check and reported that he had not needed to take any of the pain pills he was given the surgeon informed him that this was pretty much a “painless surgery.” When he asked why he been given the 30 pills he was told it was “expected.” In case you had not noticed this patient was me (Dr. Bunio) and when my wife and I were left with 30 narcotics that we did not need we did what we thought was the responsible thing and put them up on a high shelf away from children for a rainy day….but if you asked me to account for each of those pills I honestly could not do it.
According to the CDC”s provisional count of deaths for 2016 approximately 50,000 Americans died from opiate related drug overdoses with the biggest rise in fentanyl and heroin related deaths. That means by the time this 10 minute Medtalk is over one person will have lost their life to this terrible epidemic.

2. Opioid Prescription Practices in Western North Carolina
Kanof Institute for Physician Leadership: Leadership College 2017 September 2017
Richard Bunio, Anne Cotter, Miriam Schwarz

3. The epidemic
*From 1999 to 2016, more than 12,000 North Carolinians died from opioid-related overdoses, the majority of which were unintentional overdoses. opioid-related overdose deaths have increased by over 800%, resulting in over 12,000 needless deaths
*In 2015, there were more than 1,100 opioid-related deaths, a 73 percent increase from 2005

4. Methods

5. Survey Components Qualitative Biggest reason for epidemic?
What would make prescribing more comfortable?
Quantitative
Demographics (personal and practice)
Prescribing habits
Comfort/Importance

6. SURVEY Variables Demographics Comfort/Importance Best Practices
Demographics: Physician/PA, Age, Years since Training, Pain Management training, Practice Type, Practice Size, Practice Data/Feedback
Best practices: Written Policy, Pain Contract, Discuss Overdose Prevention, Urine Drug Screens, CSRS, Opiate Replacement TX- Distance to ORT
Comfort/importance: Written Policy –Comfort, Written Policy – Importance, Pain Contracts – Comfort, Pain Contracts – Importance, Prescribing Opiates – Comfort

7. 134 Surveys total RESULTS 1,428 surveys 142 responses
EXCLUSIONS
- Indicated practice or specialty not prescribing opiates (4)
- Chose not to prescribe opiates (1)
- Failed to complete survey after entering demographics (3)
134 Surveys total

8. Demographics

9. Demographics

10. RESIDENCY / MEDICAL SCHOOL
PRACTICE TYPE
EMPLOYED
39% }
92%
FQHC
14%
INDEPENDENT
32%
RESIDENCY / MEDICAL SCHOOL 7%

11. SURVEY Variables Demographics Comfort/Importance Best Practices
Demographics: Physician/PA, Age, Years since Training, Pain Management training, Practice Type, Practice Size, Practice Data/Feedback
Best practices: Written Policy, Pain Contract, Discuss Overdose Prevention, Urine Drug Screens, CSRS, Opiate Replacement TX- Distance to ORT
Comfort/importance: Written Policy –Comfort, Written Policy – Importance, Pain Contracts – Comfort, Pain Contracts – Importance, Prescribing Opiates – Comfort

12. NB – In all the graphs to follow Red is the undesired action, Green is desirable and Yellow is intermediate.

16. Importance of Pain Contract
Size of Practice

17. Using the CSRS

19. We’ll start with qualitative: this is a word map of what prescribers believe to be the causes of epidemic in their own words

20. Qualitative- What can be done?
Qualitative study- what can be done to increase comfort with prescribing

21. Qualitative study- what can be done to increase comfort with prescribing

22. Where to go from here?
Providers WANT supportive policies to help safely guide their prescribing practices.
Targeted groups: independent practice, older practitioners (CSRS), smaller practices
1)      Independent practices are least likely to have a policy or pain contract and also least likely to use the CSRS or mitigate risk.
2)      Smaller practices are also least likely to use a policy or contract and ascribe the least importance to this.
3)      Older physicians especially in the age group, while pretty comfortable with prescribing opiates are least likely to use the CSRS.

23. Thank you

24. Methods Survey Demographics Best Practices Comfort/Importance
Physician/PA
Age
Years since Training
Pain Management training
Practice Type
Practice Size
Practice Data/Feedback
Written Policy
Pain Contract
Discuss Overdose Prevention
Urine Drug Screens
CSRS
Opiate Replacement TX
- Distance to ORT
Written Policy –Comfort
Written Policy – Importance
Pain Contracts – Comfort
Pain Contracts – Importance
Prescribing Opiates – Comfort