Development of an Evidence-based Safer Prescribing Toolkit for Clinical Care

Eve Losman, MD, MHSA
Douglas Wiebe, PhD
Taylor Hautala, MPH
Jill Solomon, MPH
Nichole Burnside, MBA

Despite a reduction nationwide in new opioid prescriptions since 2012, opioid overprescribing, as well as opioid misuse and overdose, remain significant U.S. public health issues. This issue extends to pediatric populations, with approximately 4 million pediatric opioid prescriptions in 2019, 45.6% of which were considered high-risk. This underscores the importance of safe prescribing practices, particularly in settings where youth frequently receive care, such as pediatric clinics and dental offices. It is well-documented that overprescribing of opioids has markedly contributed to the opioid epidemic; more recently, overdose deaths increasingly involve stimulants and benzodiazepines, signaling the need to address polysubstance use as part of our response to the opioid epidemic. In 2019, there was a deficit in just-in-time educational resources/tools; in response, the “Safer Prescribing Toolkit” was created to offer comprehensive, evidence-based guidelines and practical tools for healthcare providers and their patients pertaining to opioids, and more recently, stimulants and benzodiazepines.

In 2018-2019, a needs assessment of Michigan primary care providers was conducted, identifying knowledge/skills gaps. Based on the results, a comprehensive review of publicly available opioid prescribing resources and a systematic literature review to identify up-to-date recommendations were conducted in key areas. Provider and patient-focused educational content and resources were curated from existing sources or newly developed. Resources were reviewed by expert researchers/clinicians for accuracy and by practicing clinicians for usability and relevance. Training series covering topics related to safe prescribing were organized to complement the online toolkit. These efforts were funded by the Michigan Department of Health and Human Services. Periodic updates with new topics, including new sections on benzodiazepines and stimulants, have expanded the toolkit’s content.

Toolkit resources are categorized across three commonly prescribed substance types: opioids, stimulants, and benzodiazepines. Several sub-categories exist within each section, including but not limited to: background resources (i.e., managing acute/chronic pain, managing anxiety/insomnia, reducing stigma), just-in-time tools (clinical decision flowcharts, screening and assessment tools), tapering/deprescribing, opioid use disorders (screening, referral, naloxone, medication for opioid use disorder), and prescribing laws (PDMPs, legal resources). In addition, there are resources and tailored information on/for special issues and populations, including adolescents, teachers and coaches, LGBTQ+, pregnant women, older adults, and more. Since its 2019 launch and subsequent updates, the toolkit pages have had over 228,000 views, suggesting high engagement with the content.

Development/dissemination of a just-in-time online toolkit to guide safe prescribing of these controlled substances, evidence-based pain and anxiety management, and substance use disorder treatment/linkage to care has potential for broad public health and clinical impact in addressing the opioid overdose epidemic. Future work on this toolkit includes responding to feedback from physicians to make the toolkit easier to navigate.

1. Understand the ongoing challenges and complexities of the opioid epidemic in the United States, including polysubstance use, and the increasing involvement of stimulants and benzodiazepines in opioid-related deaths.
2. Recognize the importance of evidence-based tools and training in promoting safer prescribing practices for all patients from childhood to older adulthood.
3. Understand the key components of the Safer Prescribing Toolkit, including its development process, target audience, and primary objectives.