USE A ONE-QUESTION SCREEN FOR OPIOID MISUSE AMONG OLDER PATIENTS

Despite growing attention on the need to increase access to treatment for opioid use disorder (OUD), not enough emphasis has been placed on OUD screening among patients prescribed long-term opioids. A significant proportion of our practice's patients on chronic opioids are 65 years or older. This group may be at higher risk for opioid-related harms, given their increased likelihood for polypharmacy, mobility limitations, renal or hepatic impairment, and social isolation.

We implemented a one-question screen for potential opioid misuse among this population during rooming. Nurses ask these patients, “In the last year, have you used your opioid medication for a purpose — or at a frequency or dose — thatis outside of what is prescribed?” Initially, our nursing colleagues expressed hesitation to do the screening, given lack of formal training in this area. To address this concern, we created a short, self-guided training module, which included instructional videos made in-house on motivational interviewing and perspective taking and content on OUD and opioid withdrawal. Surveyed nurses agreed the training increased their confidence in addressing opioid misuse and chronic pain with patients. Nearly 20% of our older adult patients screened positive for OUD, which prompted us to engage with addiction colleagues to create workflows for referrals and care coordination. Our experience demonstrates that involving nurses in screening older adults for potential opioid misuse is feasible with brief training and leads to improved care.