Changes in Single-Specialty Postoperative Opioid Prescribing Patterns in Response to Legislation: Single-Institution Analysis Over Time

2021 ◽  
Vol 164 (4) ◽  
pp. 774-780
Author(s):  
Andrew P. Katz ◽  
Carly Misztal ◽  
Michael K. Ghiam ◽  
Michael E. Hoffer
Keyword(s):  
Monitoring Program ◽  
Prescribing Patterns ◽  
Single Institution ◽  
Opioid Prescription ◽  
State Legislation ◽  
Academic Center ◽  
Prescription Drug Monitoring Program ◽  
Before And After ◽  
The Law ◽  
Time Point

Objectives To determine changes in the prescriptions of postoperative opioids in response to Florida state legislation restricting the number of days for which these medications could be prescribed to 3 days in most circumstances or 7 days at provider discretion. Study Design A retrospective review was performed for all patients undergoing 7 common outpatient otolaryngology surgical procedures. Setting Single-institution academic center in Florida. Methods Query of the state’s online prescription drug monitoring program was used to compare prescription habits 3 months before and after the law and then again 1 year later. Results A total of 561 patients were identified meeting criteria. The number of days that opioids were prescribed decreased significantly, from 6.42 to 4.48 to 3.03 days. There was a significant decrease in the proportion of patients receiving any postoperative opioid prescription, from 0.80 to 0.52 to 0.32. The total morphine milligram equivalents prescribed decreased from 28.4 before the law to 18.4 at 1 year after. Conclusions Legislative restrictions on the length of opioid prescriptions were associated with significant decreases in the proportion of patients receiving any opioids, the number of days that opioids were prescribed, and the total morphine milligram equivalents 3 months after the law went into effect, with even more dramatic changes at the 1-year time point. We opine that these changes are due to providers learning that many procedures do not require postoperative opioids and therefore increasingly considering and utilizing nonopioid alternatives in this setting.

scholarly journals Mandatory Review of Prescription Drug Monitoring Program Before Issuance of a Controlled Substance Results in Overall Reduction of Prescriptions Including Opioids and Benzodiazepines

2020 ◽  
Vol 3;23 (6;3) ◽  
pp. 299-304
Author(s):  
Alaa Abd-Elsayed
Keyword(s):  
Prescription Drug ◽  
Drug Monitoring ◽  
Monitoring Program ◽  
The United States ◽  
The State ◽  
Prescribing Patterns ◽  
P Value ◽  
Prescription Drug Monitoring Program ◽  
Before And After ◽  
Controlled Substance

Background: To date, there is limited research on whether the various types of mandatory usage of prescription drug monitoring programs (PDMP) have any effects on prescribing patterns, drug usage, patient care, and drug diversion (8-10). Within the United States (US), there is wide variation in individual states’ requirements for the usage of PDMPs. Objective: The objective of this study was to determine whether mandatory prescriber review of a PDMP prior to each issuance of a controlled substance resulted in a reduction in the total number of controlled substance prescriptions dispensed. Study Design: A retrospective review of the State of Wisconsin’s PDMP controlled substance database from April 2015 to March 2019 was performed. The evaluation compared the number of prescriptions among individual drug classes (opioids, benzodiazepines, stimulants) dispensed throughout the state before and after April 1st, 2017, when implementation of a state law mandating the review of the PDMP during each patient encounter prior to issuing a prescription for a controlled substance took effect. Setting: Research was conducted using Wisconsin’s PDMP controlled substance database from April 2015 to March 2019. During this time, controlled substance policy has come to the forefront of the nation due to issues with an opioid epidemic. Methods: Descriptive analysis was used to express data as n and % for categorical data and average ± standard deviation for numerical data. Before- and after-prescription totals were analyzed using a paired t test and Levene’s test for equality of variances. The P value was considered significant at a level ≤ .05. Limitations: Limitations to this study included its retrospective design, focus on a single US state, and possible unforeseen contributors to cause and effect. Results: Prior to the enforcement of the state’s mandatory PDMP legislation, an average of 844,314 controlled substance prescriptions were written monthly. Following the implementation of the law, the average monthly total prescriptions written within the state decreased to 708,063. This was an average monthly reduction of 136,251 prescriptions written or 16.1%. Statistically significant reductions were also seen in opioid and benzodiazepine subgroups (23.0%, 16.3%). Conclusion: Our study suggests that state-enforced mandatory usage of a PDMP, which records all controlled substance prescriptions filled by a pharmacy such as opioids, benzodiazepines, amphetamines, etc. at every encounter prior to prescribing any controlled substance, can provide for a significant reduction in controlled substance prescriptions, specifically opioids and benzodiazepines. Key words: Prescription drug monitoring program, opioids, mandatory usage, benzodiazepines, Wisconsin

The effect of a statewide prescription drug monitoring program on opioid prescribing patterns

2021 ◽  
pp. 103262
Author(s):  
Samuel J. Rubin ◽  
Judy J. Wang ◽  
Ariana Y. Nodoushani ◽  
Bharat B. Yarlagadda ◽  
Jacqueline A. Wulu ◽  
...  
Keyword(s):  
Prescription Drug ◽  
Drug Monitoring ◽  
Monitoring Program ◽  
Prescribing Patterns ◽  
Opioid Prescribing ◽  
Prescription Drug Monitoring Program

scholarly journals Reduction in Hospital System Opioid Prescribing for Acute Pain Through Default Prescription Preference Settings: Pre–Post Study

10.2196/24360 ◽  
2021 ◽  
Vol 23 (4) ◽  
pp. e24360
Author(s):  
Benjamin Heritier Slovis ◽  
Jeffrey M Riggio ◽  
Melanie Girondo ◽  
Cara Martino ◽  
Bracken Babula ◽  
...  
Keyword(s):  
The United States ◽  
Prescribing Patterns ◽  
Duration Of Treatment ◽  
Opioid Prescription ◽  
Hospital System ◽  
Opioid Prescribing ◽  
Before And After ◽  
Control And Prevention ◽  
Prescribing Practice ◽  
Quasi Experimental

Background The United States is in an opioid epidemic. Passive decision support in the electronic health record (EHR) through opioid prescription presets may aid in curbing opioid dependence. Objective The objective of this study is to determine whether modification of opioid prescribing presets in the EHR could change prescribing patterns for an entire hospital system. Methods We performed a quasi-experimental retrospective pre–post analysis of a 24-month period before and after modifications to our EHR’s opioid prescription presets to match Centers for Disease Control and Prevention guidelines. We included all opioid prescriptions prescribed at our institution for nonchronic pain. Our modifications to the EHR include (1) making duration of treatment for an opioid prescription mandatory, (2) adding a quick button for 3 days’ duration while removing others, and (3) setting the default quantity of all oral opioid formulations to 10 tablets. We examined the quantity in tablets, duration in days, and proportion of prescriptions greater than 90 morphine milligram equivalents/day for our hospital system, and compared these values before and after our intervention for effect. Results There were 78,246 prescriptions included in our study written on 30,975 unique patients. There was a significant reduction for all opioid prescriptions pre versus post in (1) the overall median quantity of tablets dispensed (54 [IQR 40-120] vs 42 [IQR 18-90]; P<.001), (2) median duration of treatment (10.5 days [IQR 5.0-30] vs 7.5 days [IQR 3.0-30]; P<.001), and (3) proportion of prescriptions greater than 90 morphine milligram equivalents/day (27.46% [10,704/38,976; 95% CI 27.02%-27.91%] vs 22.86% [8979/39,270; 95% CI 22.45%-23.28%]; P<.001). Conclusions Modifications of opioid prescribing presets in the EHR can improve prescribing practice patterns. Reducing duration and quantity of opioid prescriptions could reduce the risk of dependence and overdose.

scholarly journals Assessment of Postoperative Opioid Prescriptions Before and After Implementation of a Mandatory Prescription Drug Monitoring Program

2021 ◽  
Vol 2 (10) ◽  
pp. e212924
Author(s):  
Rivfka Shenoy ◽  
Zachary Wagner ◽  
Allison Kirkegaard ◽  
Robert J. Romanelli ◽  
Satish Mudiganti ◽  
...  
Keyword(s):  
Prescription Drug ◽  
Drug Monitoring ◽  
Monitoring Program ◽  
Prescription Drug Monitoring Program ◽  
Before And After

scholarly journals Prescription Drug Monitoring Program: Registration and Use by Prescribers and Pharmacists Before and After Legal Mandatory Registration, California, 2010–2017

2018 ◽  
Vol 108 (12) ◽  
pp. 1669-1674 ◽  
Author(s):  
Aaron B. Shev ◽  
Garen J. Wintemute ◽  
Magdalena Cerdá ◽  
Andrew Crawford ◽  
Susan L. Stewart ◽  
...  
Keyword(s):  
Prescription Drug ◽  
Drug Monitoring ◽  
Monitoring Program ◽  
Prescription Drug Monitoring Program ◽  
Before And After

scholarly journals Opioid Prescribing After Implementation of Single Click Access to a State Prescription Drug Monitoring Program Database in a Health System’s Electronic Health Record

Pain Medicine ◽  
2021 ◽  
Author(s):  
Scott G Weiner ◽  
Kimiyoshi Kobayashi ◽  
Joshua Reynolds ◽  
Kit Chan ◽  
Rodd Kelly ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Prescription Drug ◽  
Drug Monitoring ◽  
Monitoring Program ◽  
Health Record ◽  
Opioid Prescription ◽  
Number Of Patients ◽  
Prescription Drug Monitoring Program ◽  
The Mean ◽  
Electronic Health

Abstract Objectives To determine the effect of one-click integration of a state’s prescription drug monitoring program (PDMP) on the number of PDMP searches and opioid prescriptions, stratified by specialty. Methods Our large health system worked with the state department of public health to integrate the PDMP with the electronic health record (EHR), which enabled providers to query the data with a single click inside the EHR environment. We evaluated Schedule II or III opioid prescriptions reported to the Massachusetts PDMP 6 months before (November 15, 2017-May 15, 2018) and 6 months after (May 16, 2018, to November 16, 2018) integration. Search counts, prescriptions, patients, morphine milligram equivalents, as well as prescriber specialty were compared. Results There were 3,185 unique prescribers with a record of a Schedule II and/or III opioid prescription in both study periods that met inclusion criteria. After integration, the number of PDMP searches increased from 208,684 in the pre-integration phase to 298,478 searches in the post-integration phase (+43.0%). The number of opioid prescriptions dispensed decreased by 4.8%, the number of patients receiving a prescription decreased by 5.1%, and the mean morphine milligram equivalents (MMEs) per prescriber decreased by 5.4%. There were some notable specialty-specific differences in these measures. Conclusions Integration of the PDMP into the EHR markedly increased the number of searches but was associated with modest decreases in opioids prescribed and patients receiving a prescription. Single click EHR integration of the PDMP, if implemented broadly, may be a way for states to significantly increase PDMP utilization.

scholarly journals The Pennsylvania Prescription Drug Monitoring Program: Reducing the Misuse of Prescription Opioids

Commonwealth ◽  
2018 ◽  
Vol 20 (2-3) ◽  
Author(s):  
Lynn S. Mirigian ◽  
Laura A. Hendrick ◽  
Janice L. Pringle ◽  
Michael A. Zemaitis
Keyword(s):  
Prescription Drug ◽  
Drug Monitoring ◽  
Monitoring Program ◽  
Opioid Use Disorder ◽  
Prescribing Patterns ◽  
Opioid Overdose ◽  
Opioid Use ◽  
University Of Pittsburgh ◽  
Drug Enforcement Administration ◽  
Prescription Drug Monitoring Program

In 2016, 4,642 Pennsylvanians died from a drug overdose and 85% of these deaths were due to an opioid overdose (U.S. Drug Enforcement Administration and University of Pittsburgh School of Pharmacy 2017). With a 37% increase in deaths from 2015, the Commonwealth’s response to this epidemic has come from several fronts. One valuable resource has been the modernization and implementation of Pennsylvania’s Prescription Drug Monitoring Program (PDMP). PDMPs are state-­run programs that record dispensing of most controlled substances and provide this data to physicians and pharmacists (among others) to inform their practice about possible opioid use disorder by a given patient. This article discusses the role of Pennsylvania’s PDMP in patient care and law enforcement to reduce opioid overdoses in the Commonwealth. Recent evidence is discussed that demonstrates the effectiveness of state-­run PDMPs and their impact on opioid misuse and prescribing patterns. It is important to note that additional research into the effectiveness of PDMPs in preventing opioid-­related morbidity and mortality is needed.

scholarly journals Reduction in Hospital System Opioid Prescribing for Acute Pain Through Default Prescription Preference Settings: Pre–Post Study (Preprint)

2020 ◽  
Author(s):  
Benjamin Heritier Slovis ◽  
Jeffrey M Riggio ◽  
Melanie Girondo ◽  
Cara Martino ◽  
Bracken Babula ◽  
...  
Keyword(s):  
The United States ◽  
Prescribing Patterns ◽  
Duration Of Treatment ◽  
Opioid Prescription ◽  
Hospital System ◽  
Opioid Prescribing ◽  
Before And After ◽  
Control And Prevention ◽  
Prescribing Practice ◽  
Quasi Experimental

BACKGROUND The United States is in an opioid epidemic. Passive decision support in the electronic health record (EHR) through opioid prescription presets may aid in curbing opioid dependence. OBJECTIVE The objective of this study is to determine whether modification of opioid prescribing presets in the EHR could change prescribing patterns for an entire hospital system. METHODS We performed a quasi-experimental retrospective pre–post analysis of a 24-month period before and after modifications to our EHR’s opioid prescription presets to match Centers for Disease Control and Prevention guidelines. We included all opioid prescriptions prescribed at our institution for nonchronic pain. Our modifications to the EHR include (1) making duration of treatment for an opioid prescription mandatory, (2) adding a quick button for 3 days’ duration while removing others, and (3) setting the default quantity of all oral opioid formulations to 10 tablets. We examined the quantity in tablets, duration in days, and proportion of prescriptions greater than 90 morphine milligram equivalents/day for our hospital system, and compared these values before and after our intervention for effect. RESULTS There were 78,246 prescriptions included in our study written on 30,975 unique patients. There was a significant reduction for all opioid prescriptions pre versus post in (1) the overall median quantity of tablets dispensed (54 [IQR 40-120] vs 42 [IQR 18-90]; <i>P</i>&lt;.001), (2) median duration of treatment (10.5 days [IQR 5.0-30] vs 7.5 days [IQR 3.0-30]; <i>P</i>&lt;.001), and (3) proportion of prescriptions greater than 90 morphine milligram equivalents/day (27.46% [10,704/38,976; 95% CI 27.02%-27.91%] vs 22.86% [8979/39,270; 95% CI 22.45%-23.28%]; <i>P</i>&lt;.001). CONCLUSIONS Modifications of opioid prescribing presets in the EHR can improve prescribing practice patterns. Reducing duration and quantity of opioid prescriptions could reduce the risk of dependence and overdose.

Sign in / Sign up

Export Citation Format

Share Document