Development and implementation of multidisciplinary care model to address the intersection of pain and opioid use disorder among patients on long term opioid treatment

BACKGROUND: Chronic non-cancer pain and opioid use disorder (OUD) are common co-morbidities. Clinical guidelines and regulatory changes have created challenges for providers and programs in which chronic pain and OUD treatment may be sub-optimally integrated for patients receiving long-term opioid therapy (LTOT). METHODS: We identified a cohort of 61 patients in HIV primary care who met criteria for LTOT (i.e. prescribed opioids for chronic non-cancer pain >90 days) and who experienced disruptions in pain management and present an analytic case study. A multidisciplinary team developed a two-step intervention to mitigate withdrawal and overdose risk and to facilitate ongoing safe, effective pain management. RESULTS: Among 61 patients, 29.5% were receiving methadone for pain and 9.8% were receiving LTOT for pain while enrolled in methadone OUD treatment programs. All 61 LTOT patients were referred for pain management reassessment. The following assessments were made: 24.6% had chronic pain without OUD; 9.8% had OUD and transitioned to OUD treatment; 3.3% self-elected to stop opioids; 29.5% were consensually initiated on a slow consensual opioid tapering schedule. CONCLUSIONS: A multidisciplinary intervention can provide overdose risk mitigation, facilitate pain and OUD re-assessments and can guide ongoing management of cohorts of patients previously maintained on LTOT for chronic non-cancer pain.