… in the emergency department or admitted to the hospital. … Dowell D,  Ragan KR, Jones CM, et al. CDC Clinical Practice …

Adherence to prescribing guidelines for appropriate opioid dosing and duration can decrease the risk of opioid-related harm. In this retrospective analysis of nationally representative outpatient claims data, researchers found that over a 4-6 month period, 28% of Medicaid and 35% of privately-insured patients had at least one pain-related visit and 35% of all enrollees had one or more opioid prescriptions. Opioid prescribing rates varied depending on the specific medical indication and the patient’s opioid prescribing history. The researchers found that prescribing rates of many pain medical indications were not always aligned with current guidelines. For example, patients with chronic non-cancer pain conditions undergoing long-term opioid therapy were commonly prescribed daily doses above the threshold for which adverse events, such as overdose, are increased.

Viral outbreaks such as the COVID-19 pandemic place healthcare workers at risk for both adverse physical health and psychological outcomes. This evidence review examined 64 studies assessing the impact of COVID-19, Severe Acute Respiratory Syndrome (SARS), and Middle East Respiratory Syndrome (MERS) on healthcare workers and risk factors for infection. Healthcare workers accounted for a significant proportion of infections but illness severity was lower among healthcare workers than non-healthcare workers (possibly due to younger age and fewer comorbidities).  Use of personal protective equipment (PPE) and infection control training were associated with decreased infection risk.

Improving opioid prescribing is a complex challenge that requires multipronged approaches to achieve safe patient pain management. This commentary offers insights to help organizations effectively implement the Centers for Disease Control and Prevention guideline and notes how misapplication of recommendations have resulted in unintended consequences such as patient harm.

This analysis of retail prescription data revealed that opioid prescribing has declined from a peak in 2010, but it remains higher than in 1999. Increased rates of opioid prescribing occurred in areas that are not urban, have a greater proportion of white populations, and higher unemployment and Medicaid enrollment. These results are consistent with prior studies about the opioid epidemic.

Opioid medications are associated with increased risk of adverse drug events, including overdoses. This systematic review found that evidence supporting the use of long-term opioid therapy for chronic pain is lacking.

… safety , as suggested in a recent study . A previous WebM&M commentary described opioid-related harm. …

Opioid pain medications carry high risk for adverse drug events and misuse. Due to climbing rates of opioid use and associated adverse events, the Centers for Disease Control and Prevention released new guidelines for prescribing opioid medications for chronic pain. These guidelines do not apply to patients receiving cancer treatment, palliative care, or end-of-life care. The authors recommend using opioids for chronic pain only if nonopioid medications and nonpharmacologic approaches to chronic pain are not effective and prescribing immediate-release instead of long-acting medications. For acute pain, they recommend limiting duration of therapy, stating that more than 1 week of medications should rarely be needed. The guidelines also suggest minimizing concurrent use of opioids and other sedating medications and dispensing naloxone to prevent overdoses. A previous WebM&M commentary describes an adverse event related to opioids. The guidelines were updated in 2022. 

In this AHRQ-funded study, investigators conducted focus groups with patients to explore health care quality and safety issues. The authors conclude that patients can provide important insight for systems improvement and error reduction.