Changes in Opiate Prescribing Across Washington State

August 15, 2024

Changes in Opiate Prescribing Across Washington State

A View from the Top

August 15, 2024

“The amount of opioids prescribed and sold in the United States nearly quadrupled from 1999 to 2014. But, there was not an overall change in the amount of pain that Americans report.” 1

Between 2013 and 2024, the Bree Collaborative has produced seven guidelines on the topic of opioid prescribing for pain management. The result of this collection has been robust surveillance programs at the state and organizational levels which have helped providers, health systems, health plans and public health agencies monitor and reduce unnecessary prescription opioids. The overall goals of this collection of guidelines are to:

To accurately measure and transparently monitor opioid prescribing patterns
To reduce the number of naive exposures to opioids or co-prescribing incidents while still managing pain appropriately
To standardize care processes for prescribing and management of those with Opioid Use Disorder or those who are in need of long-term opioid therapy

Many organizations have used our guidelines to develop robust surveillance programs for opioid prescribing. The Everett Clinic and the PolyClinic, now part of Optum, used Bree Guidelines to inform their Chronic Opioid Therapy program development. Similarly, Delta Dental has pulled from multiple guidelines, creating provider training opportunities, patient and provider facing information, and a monitoring system with provider supports for opioid prescribing. The overall goal of these projects is to make prescribing patterns clear to clinician prescribers. Case studies on the outcomes of both of these programs are forthcoming.The Washington State Department of Labor and Industries together with the University of Washington, Kaiser Permanente, and the Foundation for Health Care Quality, published the Surveillance of Opioid Prescribing as a Public Health Intervention: Washington State Bree Collaborative Opioid Metrics “To describe development of Washington (WA) State opioid-prescribing metrics, provide purpose and definitions, and apply metrics to prescription data for WA health care organizations.”2

Bree Guidelines have informed and influenced state agencies as well. The Washington Health Care Authority (HCA) has embedded Bree Collaborative recommendations into the creation of Accountable Communities of Health (ACHs) and included three Bree metrics on the Washington State common Measure Set: New Opioid Patient Days Supply of First Opioid Prescription, New Opioid Patients Transitioning to Chronic Opioids, and Patients Prescribed High-Dose Chronic Opioid Therapy. This inclusion allows the HCA to use these metrics in contracting to support quality improvement in opioid prescribing.

The Washington State Department of Health (DOH) provides a dashboard to view data on Opioid prescribing state-wide, stratified by county or ACH. DOH has included an equity lens in their tracking of prescription opioids by measuring impacts such as Opioid deaths by age group, industry of employment, race and ethnicity, sex assigned at birth, SOGI, veterans status, and county. Bree measures included on the dashboard are:

Patients prescribed any opioid, by age group
Patients prescribed chronic opioids, all age groups
Patient prescribed high dose chronic opioids, 50+/90+/120+ MME/days per quarter
Patients prescribed any opioids and sedatives
Days supply of patients prescribed opioids, by youth or adult – 0-3 days, 4-7 days, 8-13 days and 14+ days
New opioid patient with chronic opioids
All patients with any opioid use disorder treatment formulary

In 2018 the Washington State Medical Quality Assurance Commission adopted changes to opioid prescribes laws which specifically recommend Bree Guidelines as clinical best practices for prescribing of opioids in the treatment of pain (WAC 246-919-850 to WAC 246-919-985).

System-wide the Bree Guidelines have contributed to a 51.4% drop in the rate of patients being prescribed an opioid, a 65.5% drop in the rate of patients receiving an opioid prescription with a concurrent sedative prescription, and a 76.3% drop in the rate of patients being prescribed 120+ MME per day.3 The key to this success has been clear guidance for prescribing and a shared definition of prescribing metrics to provide transparency and surveillance capacity across multiple health care system actors. The Bree’s work on opioid prescribing is a clear example of how collaborative guidelines can lead to state-wide buy-in and systemic change.

The Bree’s work to address the opioid crisis in Washington State is not yet over. In 2017 the Bree addressed treatment for Opioid Use Disorder Treatment and is currently revising the guidance to address new substances and new evidence for treatment for those suffering from OUD. For more information on these guidelines, please visit the Current Work tab on our website.

Karie Nicholas, M.A., G. Dip., Evaluation and Measurement Manager, Foundation for Health Care Quality

REFERENCES

1. Washington State Department of Health, Opioid Data. https://doh.wa.gov/data-and-statistical-reports/washington-tracking-network-wtn/opioids, Accessed July 29th, 2024.

2. Fulton-Kehoe D, Von Korff M, Mai J, Weir V, Lofy KH, Sabel J, Tauben D, Franklin G. Surveillance of Opioid Prescribing as a Public Health Intervention: Washington State Bree Collaborative Opioid Metrics. J Public Health Manag Pract. 2020 May/Jun;26(3):206-213. doi: 10.1097/PHH.0000000000001067. PMID: 31441793; PMCID: PMC7147408.

3. Washington State Department of Health, Opioid Data. https://doh.wa.gov/data-and-statistical-reports/washington-tracking-network-wtn/opioids, Accessed July 29th, 2024

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