Last March, the United States Centers for Disease Control and Prevention published the “CDC Guideline for Prescribing Opioids for Chronic Pain.” The document provides recommendations for appropriate prescribing of opioid pain relievers and other treatment options in order to improve pain management and patient safety. Recently, the agency launched the CDC Opioid Prescribing Guideline Mobile App to educate providers and inform clinical decision-making when prescribing opioids outside of active cancer treatment, palliative care and end-of-life care. This free mobile app puts the opioid prescribing guideline and other helpful content, tools and resources into prescribers’ palms at the point of care.
The tab bar at the bottom of the screen lets providers access the main tools and content—Overview, Calculator, Guideline, Interviews and Glossary—with a single tap. A “hamburger menu” (three vertical bars) at the top left also provides access to the Resources section and About page.
The brief overview emphasizes the rapid escalation of this country’s epidemic of opioid abuse and overdose deaths; acknowledges healthcare providers’ key role in protecting their patients and providing safe and effective pain management, as well as the “nuanced challenges of providing care;” and summarizes the goal of the app.
The MME (Morphine Milligram Equivalent) calculator is one of the app’s most valuable tools. It allows prescribers to quickly calculate the morphine milligram equivalent of a patient’s total daily opioid dose.
The provider selects a drug from a drop-down list, manually enters or selects the dosage, depending on the drug, and then, in most cases, selects the amount from another drop-down list. The options for dosage and amount change automatically based on the drug. For example, if codeine is selected, the provider taps in the dosage in milligrams and then selects the number of tablets daily from a drop-down list. If fentanyl transdermal is selected, the provider selects from a drop-down list of dosage options in micrograms/hour and the amount defaults to one patch every three days.
The calculated MME/day is displayed immediately after the drug, dosage and amount are entered and/or selected. If multiple opioids are prescribed, they can be entered into the calculator in succession and it will display the total MME. If the MME total for one or more opioids exceeds the guideline’s recommendation, an alert icon appears along with a Guideline button that opens a pop-up window with a cautionary statement and a summary of the relevant guideline.
This tab breaks out the CDC Guideline for Prescribing Opioids for Chronic Pain into the 12 Recommendations. A brief summary of each recommendation with key points and links to additional information make the essential information easy to access at the point of care. A Learn More button at the bottom of each summary page links to the complete guideline on the CDC website.
The Motivational Interviewing (MI) section provides an overview of this patient-centered approach to eliciting behavior change and guides prescribers through the MI framework “to help patients identify and change behaviors that place them at risk or prevent optimal chronic pain management.” Most notable are the interactive examples of patient and provider dialogue that allow providers to practice effective MI communication skills and develop confidence in both motivational interviewing and prescribing.
The Glossary defines terms such as drug abuse, drug misuse, opioid names, medication-assisted treatment (MAT), opioid use disorder and prescription drug monitoring programs (PDMPs).
The Resources section provides easy access to nearly two dozen relevant online resources:
- Clinical Tools—five fact sheets (e.g., Guideline for Prescribing Opioids for Chronic Pain: Recommendations, Calculating Total Daily Dose for Safer Dosage); a Checklist for Prescribing Opioids for Chronic Pain; and two pocket guides on Prescribing Opioids for Chronic Pain and Tapering Opioids for Chronic Pain.
Patient/Partner Tools—four fact sheets (e.g., Pregnancy and Opioid Pain Medication, Prescription Opioids: What You Need to Know) and two infographics, Why Guidelines for Primary Care Providers? and Promoting Safer and More Effective Pain Management.
Additional Resources—a fact sheet about a webinar series that provides training on the guideline, and links to eight other online resources (e.g., HHS Opioids Initiative, FDA Special Report: A Proactive Response to Prescription Opioid Abuse published in the New England Journal of Medicine, Substance Abuse and Mental Health Services Administration (SAMHSA) Opioids page, Surgeon General’s Turn the Tide Campaign).
The app is available for download on Google Play and Apple’s App Store for use on Android and iOS devices. Although accessing the full guideline and some of the other content and resources requires an internet connection, the MME calculator, the 12 key guideline summaries, the interactive Motivational Interviewing feature and the glossary are all accessible offline.
Douglas Maurer DO, MPH, FAAFP, an associate editor at iMedicalApps who recently reviewed the CDC Opioid Prescribing Guideline mobile app in MedPage Today, called it “a must have for anyone who prescribes opioids.”