Kimberly McKeirnan, PharmD, BCACP
Dr. Kimberly McKeirnan, PharmD, BCACP, is a clinical assistant professor in the Department of Pharmacotherapy at the Washington State University College of Pharmacy. She joined the faculty at WSU in 2013 after spending the previous five years working as a community pharmacist. Dr. McKeirnan has been chosen as Teacher of the Year during the 2013-2014, 2014-2015, and 2015-2016 academic years by her second-year pharmacy students. She was also the faculty preceptor on an APPE cross-cultural rotation to Ecuador in 2014.rnDr. McKeirnan is passionate about research involving community pharmacy practice as it relates to public health and improving patient access to quality care services. In 2015 Dr. McKeirnan was selected for the National Association of Chain Drug Stores (NACDS) Foundation Faculty Scholars program, a year-long program focused on community pharmacy and public health research that contributes to improving patient outcomes. Dr. McKeirnan has also received a several grants to impr
Images of parents lying unconscious, overdosed on an opioid, next to their young children have circulated frequently, leading to calls for action from the President on down. Recently updated guidelines from the CDC now suggest that a morphine milligram equivalent (MME) of greater than or equal to 20- 50 per day to be 'higher risk,' and labels >50 MME to be 'high risk,' and recommends not to exceed 90 MME per day, a reduction from previous guidelines.1 New Veterans Affairs Clinical Practice Guidelines, created in 2017 and being implemented now, suggest tapering all patients on chronic opioid therapy down to below 50 MME per day.2
All of these events combine to paint a bleak picture of drastic change necessary to stem the rising tide of opioid prescriptions. But how has opioid prescribing been trending in the last 3 years based on hard data? The recently released CDC Annual Surveillance Report of Drug-Related Risks and Outcomes presents a clearer picture.
From 2006 to 2008, the number of opioid prescriptions written increased 4.1% annually.3 From 2008 to 2012 that rate slowed to 1.1% annually, and then from 2014 to 2016, that rate dropped to an annual decrease of 5% per year.3 Essentially, compared to 2014, prescribers wrote 15% fewer opioid prescriptions this past year, which equates to a reduction of more than 26 million prescriptions.3 The number of opioid patients per 100 Americans in 2014 was 20.7, whereas at the end of last year it was 19.1.3 The average MME per prescription dropped as well, from 59.7 in 2006 to 47.1 in 2016.3
Surely these figures represent good news, and provide evidence that opioids are a problem that is being addressed at the surface level, potentially by health institutions being proactive with opioid therapy plans and programs. However, 1 area in which data suggests a potentially troubling trend is in chronic pain prescriptions—classified as prescriptions with a day’s supply greater than 30 days. This category of prescribing saw a 55% increase from 2006, when there were 17 chronic prescriptions per 100 Americans versus 27 prescriptions per 100 in 2016.3
A national survey indicated that the most common chronic condition may be low back pain, in approximately 30 percent of patients, and another study found that as many as half of all chronic opioid patients were prescribed opioids for low back pain. 4,5 For these chronic conditions, opioids are not first line or routine therapy according to CDC Pain guidelines.1 A clinical practice guideline from the American Pain Society suggests first line drug interventions of acetaminophen or NSAIDs, with spinal manipulation and other non-pharmacological options for pain resistant to self-care.6
Chronic pain is just 1 instance of rampant, potentially inappropriate opioid prescribing that highlights the potential effect pharmacists can have on almost 60 million opioid patients. As the final healthcare provider a patient will see before starting an opioid, pharmacists are uniquely positioned to educate patients and validate prescriptions. Opioid therapy outcomes are starting to trend in the right direction, and pharmacists’ significant role in this process is required to ensure and enhance this trajectory.
This article was co-written by Andrew Yabusaki, a 2018 PharmD Candidate at Washington State University, College of Pharmacy.
- Centers for Disease Control and Prevention. CDC Guidelines for Prescribing Opioids for Chronic Pain. CDC website. https://www.cdc.gov/drugoverdose/prescribing/guideline.html. Updated August 29, 2017. Accessed April 3, 2018.
- U.S. Department of Veterans Affairs. VA/DoD Clinical Practice Guidelines: Management of Opioid Therapy for Chronic Pain, Version 3.0. 2017. VA website. https://www.healthquality.va.gov/guidelines/pain/cot/. Accessed April 3, 2018.
- Centers for Disease Control and Prevention. Annual Surveillance Report of Drug-Related Risks and Outcomes—United States, 2017. CDC website. https://www.cdc.gov/drugoverdose/pdf/pubs/2017-cdc-drug-surveillance-report.pdf. Published August 31, 2017. Accessed April 3, 2018.
- National Center for Health Statistics. Health, United States, 2016. Published May 2017.
- Hudson et al. Epidemiology of regular prescribed opioid use: results from a national, population-based survey. J Pain Sympt Mgmt. 2008;36:280–288.
- Chou et al. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478–491