For many clinicians, dealing with a patient’s pain can be a difficult endeavor. While there are multiple classes of pain medications, one which receives a lot of attention due to risk of abuse and possible medical misadventures are opioids.
The class of opioids has a plethora of medications available, such as morphine, hydromorphone, fentanyl, and more. One of the hardest aspects of opioids for many clinicians is converting from one drug in the class to another. This is especially pertinent when dealing with patients adverse reactions or tolerances to a certain opioid, or establishing a daily morphine equivalent dose and changing to a fentanyl patch.
Mobile apps have offered the ability to create a pocket version of many equianalgesic opioid dosing nomograms available, with other pertinent features. The following is a review of an opioid toolbox developed for residents at a pain center.
The overall appearance of the app is relatively basic, with a simple menu screen upon initial launch. The app features an opioid risk tool, opioid conversion, refill calculator, prescribing checklist, and urine tox screen metabolites.
The Opioid Risk Tool is based off a study by Webster LR et al, where the tool has been adapted into a checklist to predict risk of potentially developing aberrant behavior in relation to opioids. This is a relatively helpful feature for those learning the practice of prescribing a high risk medication, and what to be aware of prior to initiation of opioids.
Unfortunately, the Opioid Conversion tool was not executed very well in the app. The app does not allow the direct input of doses of medications. Rather, it relies on a sliding bar at the bottom for dosing, which is relatively difficult to get accurate. This is especially the case when medications come usually in rounded doses, and not as specific as the app can choose. For instance, it would be odd to choose 13mg of morphine to find the equivalent dose with any other medication.
Lastly, the app does supply a reason for its calculation, but does not cite its resource (such as the NCCN Clinical Practice Guidelines in Oncology for Adult Pain or even a drug reference guide). Another beneficial feature the app does not incorporate is the pharmacokinetics of these drugs. For a new practitioner that information would be highly beneficial.
One feature that is relatively nice is the ability to calculate dates of refills required, especially given the stipulations of Federal Law on refilling CII medications.
In addition, one additional feature that is useful is the incorporation of a urine tox screen for metabolites, which is often a problem for those new to reading urine tox screens for opioid users.
Lastly, the app has a prescribing checklist addressing initiation of therapy and monitoring of therapy in a patient.
Evidence to support app
- A study by Haffey et al that we previously covered addressed the multiple issues facing opioid conversion apps after conducting a review of available apps at the time. They found many apps did not cite their evidence, or declare authorship.
- The main issue facing this app is the dose conversion tool which is not executed well, and the lack of citation of source of conversion information.
- Moreover, while the app does mention a clinician (included in the logo), its developer page links to a website run by an ophthalmologist, which seems odd.
- App is easy to navigate and has use outside of dose conversion
- Inclusion of pertinent information relevant to opioid prescribing
- Opioid conversion is relatively difficult to use and would benefit from the ability to directly input doses
- Inconsistent citation of clinical information utilized in app
- Support for app is questionable
- Overall, this app has several useful features that future developers would benefit incorporating into their own apps. However, as previous research has indicated, at this stage in mobile app development, there are expectations on the level of evidence and functionality for use when dealing with an app that deals with high risk medications.
- At this current time we would not recommend this app for outside use in regards to it’s intended location (i.e. developer’s pain clinic).
Device used: iPhone 4