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Impact of an Opioid Prescribing Guideline in the Acute Care Setting

      Abstract

      Background

      Death from opioid abuse is a major public health issue. The death rate associated with opioid overdose nearly quadrupled from 1999 to 2008. Acute care settings are a major source of opioid prescriptions, often for minor conditions and chronic noncancer pain.

      Objective

      Our aim was to determine whether a voluntary opioid prescribing guideline reduces the proportion of patients prescribed opioids for minor and chronic conditions.

      Methods

      A retrospective chart review was performed on records of adult emergency department visits from January 2012 to July 2014 for dental, neck, back, or unspecified chronic pain, and the proportion of patients receiving opioid prescriptions at discharge was compared before and after the guideline. Attending emergency physicians were surveyed on their perceptions regarding the impact of the guideline on prescribing patterns, patient satisfaction, and physician−patient interactions.

      Results

      In our sample of 13,187 patient visits, there was a significant (p < 0.001) and sustained decrease in rates of opioid prescriptions for dental, neck, back, or unspecified chronic pain. The rate of opioid prescribing decreased from 52.7% before the guideline to 29.8% immediately after its introduction, and to 33.8% at an interval of 12 to 18 months later. The decrease in opioid prescriptions was observed in all of these diagnosis groups and in all age groups. All 31 eligible prescribing physicians completed a survey. The opioid prescribing guideline was supported by 100% of survey respondents.

      Conclusions

      An opioid prescribing guideline significantly decreased the rates at which opioids were prescribed for minor and chronic complaints in an acute care setting.

      Keywords

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      References

        • Substance Abuse and Mental Health Services Administration
        Results from the 2009 National Survey on Drug Use and Health: volume 1: summary of national findings.
        US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, Rockville, MD2010 (Available at:) (Accessed October 3, 2011)
        • Centers for Disease Control and Prevention
        Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008.
        MMWR MMWR Morb Mortal Wkly Rep. 2014; 60: 1487-1492
        • Volkow N.D.
        • McLellan T.A.
        • Cotto J.H.
        • Karithanom M.
        • Weiss S.B.
        Characteristics of opioid prescriptions in 2009.
        JAMA. 2011; 305: 1299-1301
        • Mazer-Amirshahi M.
        • Mullins P.M.
        • Rasooly I.
        • et al.
        Rising opioid prescribing in adult US emergency department visits: 2001-2010.
        Acad Emerg Med. 2014; 21: 236-243
        • Perrone J.
        • Nelson L.S.
        Medication reconciliation for controlled substances-an ideal prescription-drug monitoring program.
        N Engl J Med. 2012; 366: 2341-2343
        • Okunseri C.
        • Okunseri E.
        • Xiang Q.
        • Thorpe J.M.
        • Szabo A.
        Prescription of opioid and nonopioid analgesics for dental care in emergency departments: findings from the National Hospital Ambulatory Medical Care Survey.
        J Public Health Dent. 2014; 74: 283-292
        • Substance Abuse and Mental Health Services Administration
        Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings.
        (NSDUH Series H-48, HHS Publication No. (SMA)) Substance Abuse and Mental Health Services Administration, Rockville, MD2014: 14-4863
        • Rolfs R.T.
        • Johnson E.
        • Williams N.J.
        • Sundwall D.N.
        Utah Department of Health. Utah clinical guidelines on prescribing opioids for treatment of pain.
        J Pain Palliat Care Pharmacother. 2010; 24: 219-235
        • Oregon College of Emergency Physicians
        Oregon emergency department (ED) opioid prescribing guidelines.
        2012 (Available at:) (Accessed February 19, 2015)
        • Baehren D.F.
        • Marco C.A.
        • Droz D.E.
        • Sinha S.
        • Callan E.M.
        • Akpunonu P.
        A statewide prescription monitoring program affects emergency department prescribing behaviors.
        Ann Emerg Med. 2010; 56: 19-23
        • Krebs E.E.
        • Carey T.S.
        • Weinberger M.
        Accuracy of the pain numeric rating scale as a screening test in primary care.
        J Gen Intern Med. 2007; 22: 1453-1458
        • Millard W.B.
        Grounding frequent flyers, not abandoning them: drug seekers in the ED.
        Ann Emerg Med. 2007; 49: 481-486
        • Dart R.C.
        • Surratt H.L.
        • Cicero T.J.
        • et al.
        Trends in opioid analgesic abuse and mortality in the United States.
        N Engl J Med. 2015; 372: 241-248