In 2007, Washington State released a guideline for chronic opioid therapy (COT) that recommended a ceiling dose. In 2010, the guideline was enhanced with recommendations for risk stratification and monitoring (RSM) and enacted as state law. In response to the guideline, Group Health’s Integrated Group Practice (GH-IGP; intervention setting) reduced opioid doses for COT patients beginning in 2007. In October 2010, the practice implemented a multifaceted RSM initiative. Group Health Contracted Care practices (GH-CC; control setting) did not implement either organized dose reduction or RSM initiatives. The marked differences in COT management between intervention and control settings permitted a natural experiment in which relevant outcomes among COT patients in the 2 care settings were compared, providing the first controlled evaluation of COT dose reduction and RSM initiatives.
