Opioid Prescribing Guidelines in Caldwell County, NC

Dissemination of opioid prescribing guidelines in a rural county reduced diversion of prescribed opioids

This county-wide program, run by a Community Care of North Carolina task force, developed and disseminated a guideline on opioid prescribing for primary care clinicians that encouraged the signing of pain contracts, requiring random drug screens, and requiring random pill counts.

A pivotal role was played by the nurse coordinator in implementing the program in primary care settings and in collecting post-intervention survey data from clinicians.

The major observed outcome was a drop in opioid pill confiscations as reported by law enforcement following guideline implementation. Clinicians also reported being more confident in their ability to manage and treat chronic pain patients.

Opioid pill confiscations in Caldwell County dropped 300% after implementation of this program. 

Continuum of Care
Type of Evidence
Response Approach
Cautious Opioid Prescribing
Peer-reviewed Article

Evidence of Program Effectiveness

A peer-reviewed evaluation found that opioid pill confiscations in Caldwell County dropped 300% two years after the implementation of the guidelines. A majority of clinicians responding to a survey reported improved management of patients with chronic pain and feeling more confident in treating them. The program did not require significant additional resources on the part of primary care offices and was notably a grass-roots, community-based initiative that generated participant buy-in. Limitations include the presence of other factors that may have decreased the diversion of opioid medications in the county (Bujold et al., 2012).