[Federal Register Volume 85, Number 53 (Wednesday, March 18, 2020)]
[Notices]
[Pages 15475-15476]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-05612]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality


Agency Information Collection Activities: Proposed Collection; 
Request

AGENCY: Agency for Healthcare Research and Quality (AHRQ), Department 
of Health and Human Services (HHS).

ACTION: Request for information (RFI).

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SUMMARY: For the ``Opioid Management in Older Adults'' project, AHRQ is 
seeking to identify innovative approaches to managing opioid 
medications for chronic pain that are particularly relevant for older 
adults. Use of long-term opioid therapy in older adults can be 
especially problematic because of increased risks such as delirium, 
falls, and dementia.

DATES: Information must be received by April 25, 2020.

ADDRESSES: Written comments should be submitted by email to: 
[email protected].

FOR FURTHER INFORMATION CONTACT: Parivash Nourjah, 
[email protected], or 301-427-1106.

SUPPLEMENTARY INFORMATION: The United States is in the midst of an 
unprecedented opioid epidemic that is affecting people from all walks 
of life. Regulators and policy makers have initiated many activities to 
curb the epidemic, but relatively little attention has been paid to the 
growing toll of opioid use, opioid misuse and opioid use disorder (OUD) 
among older adults.
    The opioid crisis in older adults is strongly related to challenges 
in prescription opioid management in this population. Older adults have 
a high prevalence of chronic pain and are especially vulnerable to 
suffering adverse events from opioid use, making safe prescribing more 
challenging even when opioids are an appropriate therapeutic choice. 
Identifying adverse effects due to opioid use, misuse or abuse is 
complicated further by factors such as co-occurring medical disorders 
that can mimic the effects of opioid use. There is also a risk of 
attributing clinical findings in older adults (e.g. personality 
changes, falls/balance problems, difficulty sleeping, and heart 
problems) to other conditions that are also common with age. If adverse 
events due to opioid prescriptions are identified, finding appropriate 
alternatives for pain management can be challenging if other 
pharmacologic options (such as NSAIDS) are contraindicated or mobility 
issues limit access to other therapeutic options.
    Diagnosis of substance use disorders is also more complicated in 
this population. Clinicians may not associate drug misuse or addiction 
with older adults or they may be inadequately trained in identification 
and treatment of opioid misuse and OUD among older adults, and hence 
may not monitor for the signs of opioid use disorder in this 
population.
    Successfully optimizing the prescribing and use of opioids in older 
adults will require addressing the issue at many points along the care 
continuum where older adults may need additional attention or a 
different approach. AHRQ wants to identify specific tools, strategies 
and approaches to opioid management in older adults throughout the 
breadth of the care delivery continuum, from avoiding opioid initiation 
to screening for opioid misuse and opioid use disorder, as well as 
approaches to opioid tapering in older adults.
    AHRQ is interested in all innovative approaches that address the 
opioid management concerns in older adults listed above, but 
respondents are welcome to address as many or as few as they choose and 
to address additional areas of interest not listed.
    Strategies and approaches could come from a variety of health care 
settings including, but not limited to, primary care and other 
ambulatory care clinics, emergency departments, home health care 
organizations, skilled nursing care settings, and inpatient care. Other 
sources of these strategies might include health care payers, 
accountable care organizations, and organizations that

[[Page 15476]]

provide external quality improvement support. Some of the examples of 
the types of innovations we are looking for might be specific tools or 
workflows that support providers to assess the risk/benefit balance of 
opioids within a multidisciplinary approach in pain management; to 
optimize and monitor the opioid prescribing when appropriate, including 
tapering strategies; to screen and treat for opioid misuse or opioid 
use disorder; or to involve family or other caregivers of an older 
adult in conversations about opioid safety. Descriptions of strategies 
or approaches should include the setting where it is deployed and the 
type of patient population served.
    This RFI is for planning purposes only and should not be construed 
as a policy, solicitation for applications, or as an obligation on the 
part of the Government to provide support for any ideas in response to 
it. AHRQ will use the information submitted in response to this RFI at 
its discretion, and will not provide comments to any respondent's 
submission. However, responses to the RFI may be reflected in future 
solicitation(s) or policies. Respondents are advised that the 
Government is under no obligation to acknowledge receipt of the 
information received or provide feedback to respondents with respect to 
any information submitted. No proprietary, classified, confidential or 
sensitive information should be included in your response. The 
Government reserves the right to use any non-proprietary technical 
information in any resultant solicitation(s). The contents of all 
submissions will be made available to the public upon request. 
Submitted materials must be publicly available or able to be made 
public.

    Dated: March 12, 2020.
Virginia Mackay-Smith,
Associate Director, Office of the Director, AHRQ.
[FR Doc. 2020-05612 Filed 3-17-20; 8:45 am]
 BILLING CODE 4160-90-P