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Monitoring long-term opioid therapy and chronic noncancer pain in primary care: Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP)

Amber Martinson, PhD, Patricia Hopkins, PhD, Amanda Kutz, PhD, William R. Marchand, MD, Julie Carney, RN, Katherine Sadler, RN, Jamie Clinton-Lont, MS, CNP


Objective: To replicate and extend previous research by examining, among a larger sample, the effectiveness of a Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP) at increasing adherence to the Veteran Affairs/Department of Defense (VA/DoD) recommended guidelines for long-term opioid therapy among chronic noncancer patients seen in primary care—medications, hospitalization, monitoring/safety, assessment, and  nonpharmacological pain treatment referrals.

Design/methods: Using data collected from medical records, a between-subjects comparison (PC-POP enrollees vs nonenrollees) was conducted to determine if there were differences between the groups 12 months post-enrollment in PC-POP (12 months post-index date for nonenrollees). Additionally, a within-subjects comparison of outcomes was also conducted with PC-POP enrollees, ie, 12 months pre-enrollment to 12 months post-enrollment.

Subjects: A convenience sample of adult Veterans with chronic noncancer pain receiving opioid therapy consecutively for 3 months in primary care.

Results: A total of 734 Veterans (423 PC-POP enrollees and 311 nonenrollees) were included in the analyses. Results showed increased concordance with VA/DoD guidelines among those enrolled in PC-POP, characterized by increased documentation of urine drug screens, Stratification Tool for Opioid Risk Mitigation reports, Narcan education/prescriptions, assessment measures for mental health/substance use/physical function, and referrals for nonpharmacological pain treatment. A decrease in morphine equivalent daily dose among patients enrolled in PC-POP across a 2-year timeframe was also found.

Conclusions: PC-POP increases guideline concordant care for providers working in primary care.


chronic pain; opioid therapy; primary care; opioid monitoring program

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