Clinical Strategies for the Treatment and Management of Patients Prescribed Long-term Opioid Therapy

Jessica J. Wyse, Linda Ganzini, Steven K. Dobscha, Erin E. Krebs, Janet Zamudio, Benjamin J. Morasco

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Objectives: Across diverse health care systems, growing recognition of the harms associated with long-term opioid therapy (LTOT) for chronic pain has catalyzed substantial changes to policy and practice designed to promote safer prescribing and patient care. Although clear goals have been defined, how clinics and providers should most effectively implement these changes has been less well defined, and facilities and providers have had substantial flexibility to innovate. Methods: Qualitative interviews were conducted with 24 Department of Veterans Affairs (VA) clinicians across the United States who prescribe LTOT for chronic pain. Interviews probed the practices and initiatives providers utilized to meet opioid safety requirements and address common challenges in caring for patients prescribed LTOT. Results: Innovative strategies in the design and organization of clinical practice (urine drug testing, informed consent, limiting transfer requests, specialty patient panel) and resources utilized (engaged pharmacists, non-opioid pain treatments, intra-organizational collaborations) are described. Conclusions: We conclude with recommendations designed to improve opioid prescribing practices, both within the VA and in other settings.

Original languageEnglish (US)
Pages (from-to)1737-1744
Number of pages8
JournalPain Medicine (United States)
Issue number9
StatePublished - Sep 1 2019

Bibliographical note

Publisher Copyright:
© 2018 American Academy of Pain Medicine.


  • Chronic Pain
  • Innovations
  • Long-term Opioid Therapy
  • Qualitative Research
  • Veterans


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