Reducing high-dose opioid prescribing in primary care: effectiveness of opioid safety committees

Prescription opioids remain a leading cause of morbidity and mortality in the United States despite ongoing efforts to reduce misuse. Though there are evidence-based guidelines to reduce high-risk prescribing practices, health systems need practical strategies and support to implement recommendations. Interdisciplinary opioid safety committees (OSCs) may help reduce opioid prescribing in primary care, but evidence of their effectiveness is limited. Our objective was to evaluate the effectiveness of OSCs to reduce high-dose opioid prescribing and identify facilitators, barriers, and team impacts of implementation. We used a mixed methods approach, including a pragmatic stepped wedge design and semi-structured interviews with 55 OSC members. Four patient partners guided the project team throughout. The population included all adult patients on any opioid dose (MME > 0) from August 2019 to December 2023 at a large integrated health system with 28 primary care clinics in Washington state. Sub-analyses focused on 9 primary care clinics with OCSs. The sample included 19.4 million person-months for 635,397 unique patients, including 6.9 million person-months for 277,317 patients in OSC clinics. We found a 19% relative decline in high-dose opioid prescribing (MME > = 90) in OSC clinics, with significant results only after one year (RR 0.81, 95% CI 0.67 to 0.97 after > 12 months). Similar results occurred for prescribing of MME > = 50 and concurrent prescribing of opioids with benzodiazepines. Facilitators to implementing OSCs included interdisciplinary teams; the patient-centered approach; collaboration with the patient’s primary care provider; and virtual practice facilitation. Challenges included limited pain treatment options; provider resistance to peer review; scheduling difficulties; and patient complexity. OSCs supported by virtual practice facilitation effectively reduced high-dose opioid prescribing in primary care, though significant results required over 12 months. This underscores the importance of sustaining and supporting OSCs over time.