Opioid Prescribing Improvement Program

Governor Mark Dayton and the Minnesota Legislature enacted the Opioid Prescribing Improvement Program (Minnesota Statutes, 256B.0638) in 2015 to reduce opioid dependency and misuse in Minnesota related to opioid prescriptions as public awareness of the opioid crisis grew in the early 2010s.

Program goals, deliverables and outcomes

Program goals

The goals of the Opioid Prescribing Improvement Program (OPIP) were to work collaboratively with the Minnesota medical community to:

Reduce inappropriate or excessive opioid prescribing for acute and post-acute pain
Reduce inappropriate variation in opioid prescribing for acute and post-acute pain
Support patients who remain on chronic opioid analgesic therapy through patient-centered, multimodal treatment approaches, improved monitoring of safety and harm reduction strategies.

Program deliverables

Statute dictated that the OPIP must fulfill five succinct program components to accomplish the program goals. Those program components include the development of:

Prescribing protocols that address all phases of the opioid prescribing cycle (acute, post-acute and chronic)
Patient education tools for providers to communicate with patients about pain and the use of opioids to treat pain
Sentinel prescribing measures to assess prescribing norms and variation, and to support improvement in clinical practice
A set of quality thresholds for MHCP-enrolled providers that indicate the need for quality improvement work; and
Sanction standards for MHCP-enrolled providers who persistently demonstrate dangerous prescribing practices

Program outcomes

The following table shows wide-spread reduction in opioid prescribing to MHCP members between 2016 and 2022. All but one of seven measures saw a 40% reduction or more over this timeframe.

Changes in opioid prescribing trends (2016-2024)

Measure	Measure Description	2016	2024	% Change
Measure 1	Number of Index Opioid prescriptions	152,132	87,972	-57.8%
Measure 2	Percent Index Opioids > 100 MME	51.50%	24.97%	-48.5%
Measure 3	Percent of opioid Rx in initial episode > 700 MME	11.60%	4.92%	-42.4%
Measure 4	Number of COAT recipients	21,667	9,028	-41.7%
Measure 5	Percent of high-dose COAT recipients	13.90%	6.86%	-49.3%
Measure 6	Percent of COAT recipients with concomitant benzos	11.70%	5.39%	-46.1%
Measure 7	Percent of COAT recipients with >2 prescribers	10.10%	13.41%	32.5%

Opioid Prescribing Work Group
Overview

The Opioid Prescribing Work Group (OPWG) was an advisory body of experts convened to forward Minnesota Department of Human Services’ (DHS) Opioid Prescribing Improvement Program. The work group was tasked with advising DHS as it developed these program components:
- Prescribing protocols that address all phases of the opioid prescribing cycle
- Educational tools for providers to use in communicating with patients about pain and the use of opioids to treat pain
- Sentinel prescribing measures to assess variation and support improvement in clinical practice
- A set of quality thresholds directed at MHCP-enrolled providers that indicate the need for quality improvement work; and
- Sanction standards for MHCP-enrolled providers who persistently demonstrate dangerous prescribing practices
The OPWG served for six years (between November 2015 and December 2021). Twice during that period, the Commissioner of DHS authorized a two-year extension to ensure the OPWG could complete program objectives. Over the course of about 50 meetings, OPWG members contributed their time and expertise, with hours of work outside those meetings.

The OPWG members exhibited a strong commitment to public service and collaboration. They worked towards a shared vision that all Minnesotans could expect safe, evidence-based treatment of pain.
Work Group Members
Work group members were appointed by the Commissioner of DHS according to statutorily set membership categories. Members were eligible for a $200 honorarium per meeting and reimbursement for mileage and parking. Many members served the entire six-year duration of the workgroup, while others left due to attrition from their professional roles. The following is a list of all contributing members of the OPWG under their respective membership categories:
- Community member who uses or who has used opioid therapy to manage chronic pain
  - Kurtis Couch, Waterville
  - Saudade SammuelSon, Richfield
- Consumer representative
  - Matthew Lewis, MD (not practicing), Winona
  - Sen. Chris Eaton, RN, Minnesota State Senate
- Dentist
  - Richard Nadeau, DDS, MPH, University of Minnesota School of Dentistry
- Health plan medical director
  - Bret Haake, MD, HealthPartners
  - Bradley Johnson, MD, South Country Health Alliance
  - Alvaro Sanchez, MD, Medica
- Health plan pharmacy director
  - Adam Nelson, PharmD, CSP, UCare
  - Pete Marshall, PharmD, HealthPartners
- Law enforcement
  - Detective Charles Strack, Little Falls Police Department
  - Sgt. Matthew J. St. George, Minneapolis Police Department
- Licensed physician
  - Kurt DeVine, MD, CentraCare
  - Ifeyinwa Nneka Igwe, MD, Essentia Health
- Medical examiner
  - Lindsey Thomas, MD, Midwest Medical Examiner’s Office, retired
- Mental health professional
  - Charles Reznikoff, MD, Hennepin County Medical Center
- Minnesota Department of Health (nonvoting)
  - Dana Farley, MS
- Minnesota Department of Human Services (Minnesota Health Care Programs medical director; nonvoting)
  - Nathan Chomilo, MD
  - Jeffrey Schiff, MD, MBA
- Minnesota Department of Human Services (DHS pharmacy unit; nonvoting)
  - Chad Hope, PharmD
  - Mary Beth Reinke, PharmD, MSA
- Minnesota Department of Human Services Health Services Advisory Council member
  - Chris Johnson, MD, Allina Health
- Minnesota Department of Labor and Industry (medical consultant; nonvoting)
  - Emily Bannister, MD
  - Ernest Lampe, MD
- Nonphysician health care professional who treats pain
  - Julie L. Cunningham, PharmD, BCPP, Chair, Mayo Clinic Health System
  - Murray McAllister, PsyD, LP, Courage Kenny Rehabilitation Institute
- Nurse practitioner
  - Rebekah Forrest, RN, CNP, NorthPoint Community Clinic (nurse)
- Pharmacist
  - Tiffany Elton, PharmD, NCPS
Work Group Meeting Materials
OPWG meeting materials, including agenda, minutes, and slides are available here.

2021
2020
2019
2018
2017
2016
2015
- Nov. 23 agenda (PDF) | meeting minutes (PDF)
- Dec. 14 agenda (PDF) | meeting minutes (PDF)
Program Sunset
The OPIP program officially ended on Dec. 31, 2024, when the Minnesota Legislature passed language to sunset the OPIP program in 2023 Session Law SF2934 Article 6, section 6.

DHS staff convened a panel of experts to establish objective criteria to indicate OPIP accomplished its statutorily defined goals per the statute. A report with the Commissioner’s full recommendation is available in the Sunset Recommendations for the OPIP (PDF).

The panel defined two criteria by which the OPIP should be sunset, intentionally linking their criteria to the initial OPIP goals defined in statute. The sunset panel determined the OPIP program could conclude when:
1. Inappropriate or excessive opioid prescribing for acute and post-acute pain decreased by 40% between 2016 and 2022.
2. Inappropriate variation in opioid prescribing for acute and post-acute pain decreased by 50% between 2016 and 2022.
The sunset panel also evaluated the third OPIP goal which was to support patients who remain on chronic opioid analgesic therapy through patient-centered, multimodal treatment approaches, improved monitoring of safety and harm reduction strategies. The panel concluded there was no criteria to objectively measure Goal 3 and abstained from making a sunset recommendation to the legislature on OPIP’s third goal.
Reports to the Legislature
Annual program reports to the legislature are required in statute (Minnesota Statutes, 256B.0638, subdivision 7). A history of OPIP’s legislative reports is available in the Legislative Reference Library:
- March 2016: Opioid Prescribing Improvement Program March 2016 (PDF)
- September 2016: Opioid Prescribing Improvement Program September 2016 (PDF)
- September 2017: Opioid Prescribing Improvement Program September 2017(PDF)
- September 2018: Opioid Prescribing Improvement Program 2018 Legislative Report (PDF)
- September 2019: Legislative Report Opioid Prescribing Improvement Program 2019 (PDF)
- September 2020: Legislative Report Opioid Prescribing Improvement Program 2020 (PDF)
- September 2021: Opioid Prescribing Improvement Program 2021 (PDF)
- January 2024: Sunset Recommendations for the Opioid Prescribing Improvement Program (PDF)