Making a Difference
In the last five years, opioid prescription rates, MMEs (morphine milliequivalents) and overlapping opioid/benzodiazepine prescriptions in Siskiyou County have decreased dramatically. Safe prescribing practices are at the core of these efforts.
Clinics and private practitioners have adopted consistent policies that outline evidence-based practices relating to opioid prescribing.
Our Coalition has held trainings for prescribers, and instituted a program of academic detailing where experienced local prescribers met one-on-one with other practitioners to discuss safe prescribing practices and other topics of concern. The coalition also promoted the co-prescription of naloxone to patients receiving opioids and disseminated information and updates regarding California’s prescription drug monitoring program, CURES.
General Guidelines for Safe Prescribing
According to American Family Physician, all prescribers should:
- Step 1. Evaluate and Clearly Define the Patient’s Problem
- Step 2. Specify the Therapeutic Objective
- Step 3. Select the Appropriate Drug Therapy
- Step 4. Initiate Therapy with Appropriate Details and Consider Nonpharmacologic Therapies
- Step 5. Give Information, Instructions, and Warnings
- Step 6. Evaluate Therapy Regularly
- Step 7. Consider Drug Cost When Prescribing
- Step 8. Use Computers and Other Tools to Reduce Prescribing Errors
Four Evidence‐Based Strategies to Safer Opioid Prescribing
1. Not On Chronic Opioids?
- For acute pain: Don’t Start. Use alternatives, or judicious, short‐term immediate release opioids.
- For chronic non‐cancer pain: Don’t start. Use alternatives.
2. On Opioids?
- Taper to lower, safer doses.
3. Treat addiction with effective medications & counseling
4. Increase availability and access to naloxone.
Motivational Interviewing (MI)
More than a technique, Motivational Interviewing is an approach that is effective in moving patients struggling with opioid use issues towards positive outcomes. You don’t need to be a counselor or behavioral health specialist to utilize these principles; prescribers and other health care professionals will find them extremely useful, too.
Motivational Interviewing focuses on exploring motivational processes that facilitate change.
The basic principles of MI have been applied in numerous settings, and research findings have demonstrated their effectiveness. MI is now established as an evidence-based practice in the treatment of individuals with substance use disorders (SUD).
The main goals of MI are to engage clients, elicit change talk, and evoke motivation to encourage positive change.
Basic techniques in MI include:
- Asking open-ended questions
- Providing affirmations
- Reflective listening
- Providing summary statements to the client
- Non-judgmental, non-confrontational, non-adversarial communication
- Warmth, empathy, acceptance
MI is a collaborative, person-centered form of guiding clients towards sourcing motivation for change. Learn more about MI and find resources on our Resources & Education page.