One of the most common methods of managing chronic pain is using opioid analgesics, which are frequently - and often unnecessarily - prescribed as a first-line therapy. However, use of opioids comes with serious risks, including opioid addiction and overdose.
Unfortunately, the trend of increasing opioid prescriptions continues, contributing to the nationwide epidemic of prescription opioid overdose.
The CDC data shows that overdose deaths involving opioids have quadrupled since 1999. From 1999 to 2015, more than 183,000 people died from overdose related to prescription opioids.
Healthcare providers play a key role in protecting the patients, by providing safe and effective pain management.
Knowing how challenging this task is, the CDC published the Guideline for Prescribing Opioids for Chronic Pain to provide recommendations for primary care providers who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.
CDC also published a CDC Opioid Guideline mobile app as a quick reference guide to help healthcare providers apply these recommendations to their daily clinical practice and make informed opioid prescribing decisions.
The app contains 12 current, up-to-date CDC recommendations from 2016, which cover wide range of topics, including the suggestions to avoid opioids as first-line therapy, to discuss risks and benefits with their patients, to rather use short-term opioids, or lowest effective doses, and many more.
The recommendations are written in a form of concise instructions, i.e. summary with key points and links to additional information (full recommendation documents, fact sheets, guides, and many more).
For example, the Recommendation 1 suggests providers to avoid opioids as first-line or routine therapy for chronic pain (except cancer, palliative, or end-of-life care) and to carefully weight expected benefits against risks. Recommendation 5 suggests providers to use lowest effective dose and to be careful about the daily morphine milligram equivalent, i.e. to avoid increasing dosage to ≥90 MME/day.
For this purpose, the CDC Opioid Guideline app also includes Morphine Milligram Equivalent (MME) calculator to help reduce the risk of opioid overdose.
We already reviewed OpioidCalc app, a standalone app made by NYC Department of Health and Mental Hygiene that calculates the total daily morphine milligram equivalents (MME) in simple and easy-to-use way.
CDC Opioid Guideline app calculates daily morphine milligram equivalents in similar fashion. Users can tap on plus symbol to add a drug from a list of 9 commonly prescribed opioids with their generic names, including codeine, fentanyl patches, hydrocodone, oxymorphone, etc.
The users can also input dosage in milligrams, or mcg/hr for fentanyl patches, as well as daily amount of the opioid. The app then calculates the daily MME and provides users with the guideline, referencing them to particular recommendation.
For example if the patient is using one fentanyl transdermal patch every 3 days with the total dose of 12.5 mcg/hr, the daily MME would be 30, which falls within recommended level of <50 MME/day. The app would suggest you to check Recommendation 5 on using the lowest effective dose.
If the patient also uses 20mg of Vicodin twice a day, the MME would be 50 and you'd get a suggestion to check Recommendation 7 and consider discontinuing or tapering the opioid if the benefits do not outweigh the risks.
There is an increased risk of overdose if the daily MME is equal or above 90, so you'd be warned to avoid them or carefully justify these doses if the calculator shows that patient's medication and doses reached ≥90 MME/day. You'd be also suggested to refer to the specialist and schedule reassessment at least every 3 months.
Along with the recommendations and MME calculator, the app also includes a glossary of common used terms and an interactive Motivational Interviewing feature that helps healthcare providers to practice their communication skills with their patients, i.e. teaching them about the course of the interview, what type of questions they should avoid, etc. Motivational Interviewing, however, contains limited number of questions, so it could benefit from additional scenarios.
The app is well referenced, linking to CDC website as the main resource. Checking additional info (provided mainly as PDF documents) works better if you use the app on iPhone, because all linked materials open within the app, while Android users must leave the app and see the linked materials in their phone browser. In both cases, you'll need an Internet connection.
As a conclusion, the CDC Opioid Guideline app is a great all-in-one resource that provides an easy to follow authority guidelines on opioid prescriptions, MME calculator, and helpful tips on motivational interviewing. This is why I recommend this app for everyday use.
Benefit: All healthcare providers who are prescribing opioid analgesics for pain management