Department of Research & Evaluation News

A Kaiser Permanente study of nearly 2,500 patients who used high doses of opioids for at least 6 months showed that reducing their opioid use did not lower their satisfaction with care. The study, “Satisfaction With Care After Reducing Opioids for Chronic Pain,” was published today in The American Journal of Managed Care.

“Physicians are often concerned they will receive lower satisfaction scores if they reduce opioids for patients who are accustomed to high opioid doses to manage chronic pain,” said the study’s lead author, Adam L. Sharp, MD, MS, of Kaiser Permanente Southern California Department of Research & Evaluation. “This study showed that following current recommendations and reducing opioids for chronic pain did not result in lower satisfaction scores.”

Opioid use has been a major health concern in the U.S. Opioid use increased in the United States by 300% from 1997 to 2010, and overdose deaths increased 200% from 2000 to 2014. An in-depth analysis of U.S. data released by the Centers for Disease Control and Prevention in March showed that drug overdoses killed 63,632 Americans in 2016 and nearly 2/3 of those deaths involved a prescription or illicit opioid.

But reducing opioids for patients who have been prescribed the medications for many years to manage chronic pain can be challenging for physicians. One concern is reduced patient satisfaction. Researchers tracked patient encounters from 2009 to 2014 among Kaiser Permanente members in Southern California. They included 2,492 encounters with patients prescribed high doses of opioids for at least 6 consecutive months for chronic pain.

The study compared patient satisfaction scores between those whose dose was reduced to the recommended level for at least 30 days following the encounter on which the satisfaction score was linked and those without such a reduction. It found:

• Most encounters resulting in an opioid dose reduction maintained favorable overall satisfaction (86.4%).
• Reducing opioid doses for chronic pain was not associated with unfavorable patient satisfaction scores.
• The odds of a favorable satisfaction rating were higher when opioids were reduced by a patient’s regular primary care physician versus a different physician.

“If you are physician, you should do the right thing and you should feel comfortable you will not receive lower patient satisfaction scores. Our results should reassure physicians and help promote use of recommended guidelines,” Dr. Sharp said. “Even if you are in the small subset of physicians reducing opioids for people who are not your regular patients, there is still only small difference in overall patient satisfaction.”

Dr. Sharp, who is an emergency room physician as well as a researcher, said there is a message for patients as well: “Even if you have been on opioids for years, the recommendations have changed.”

He noted that physicians have learned that the high doses previously used were more likely to hurt patients than to help them with their pain.

“You should be reassured that your physician wants to follow guidelines designed to improve your health and well-being,” he said. “At times, your doctor may be helping you most by prescribing less.”

Other authors include senior author Michael K. Gould, MD, MS, Ernest Shen, PhD, Yi-Lin Wu, MS, and Adeline Wong, MPH, of the Kaiser Permanente Southern California Department of Research & Evaluation; Michael Menchine, MD, MS, of the Department of Emergency Medicine, University of Southern California, Los Angeles, and Michael H. Kanter, MD, medical director of Quality and Clinical Analysis, Kaiser Permanente Southern California and executive vice president of Quality and chief quality officer, The Permanente Federation, Oakland, California.

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About the Kaiser Permanente Southern California Department of Research & Evaluation

The Department of Research & Evaluation conducts high-quality, innovative research into disease etiology, prevention, treatment and care delivery. Investigators conduct epidemiologic research, health services research, biostatistics research, and behavioral research as well as clinical trials. Major areas of study include chronic disease, infectious disease, cancer, drug safety and effectiveness, and maternal and child health. Headquartered in Pasadena, California, the department focuses on translating research to practice quickly to benefit the health and lives of Kaiser Permanente Southern California members and the general public. Visit kp.org/research.

About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 12.2 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.