Advertisement

The Effect of a Statewide Mandatory Prescription Drug Monitoring Program on Opioid Prescribing by Emergency Medicine Providers Across 15 Hospitals in a Single Health System

Published:December 11, 2017DOI:https://doi.org/10.1016/j.jpain.2017.11.010

      Highlights

      • Mandated prescription monitoring reduced opioid prescribing among emergency medicine providers.
      • There was heterogeneity in opioid prescribing across hospitals and by patient diagnosis.
      • Reductions in opioid prescriptions could help curb the opioid epidemic.

      Abstract

      Prescription drug monitoring programs (PDMPs) enable registered prescribers to obtain real-time information on patients' prescription history of controlled medications. We sought to describe the effect of a state-mandated PDMP on opioid prescribing by emergency medicine providers. We retrospectively analyzed electronic medical records of 122,732 adult patients discharged with an opioid prescription from 15 emergency departments in a single health system in Pennsylvania from July 2015 to March, 2017. We used an interrupted time series design to evaluate the percentage of patients discharged each month with an opioid prescription before and after state law-mandated PDMP use on August 25, 2016. From August (pre-PDMP) to September, 2016 (post-PDMP), the opioid prescribing rate decreased from 12.4% (95% confidence interval [CI], 10.8%-14.1%) to 10.2% (95% CI, 8.8%-11.8%). For each month between September 2016 to March 2017, there was a mean decline of .46% (95% CI, −.38% to −.53%) in the percentage of patients discharged with an opioid prescription. There was heterogeneity in opioid prescribing across hospitals as well as according to patient diagnosis.

      Perspective

      This study examined the effect of a state-mandated PDMP on opioid prescribing among emergency medicine providers from 15 different hospitals in a single health system. Findings support current PDMP mandates in reducing opioid prescriptions, which could curb the prescription opioid epidemic and may ultimately reduce abuse, misuse, and overdose death.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bao Y.
        • Pan Y.
        • Taylor A.
        • Radakrishnan S.
        • Luo F.
        • Pincus H.A.
        • Schackman B.R.
        Prescription drug monitoring programs are associated with sustained reductions in opioid prescribing by physicians.
        Health Aff (Millwood). 2016; 1: 1045-1051
        • Barnett M.L.
        • Olenksi A.R.
        • Jena A.B.
        Opioid prescribing by emergency physicians and risk of long-term use.
        N Engl J Med. 2017; 11: 1896
        • Bohnert A.S.
        • Valenstein M.
        • Bair M.J.
        • Ganoczy D.
        • McCarthy J.F.
        • Ilgen M.A.
        • Blow F.C.
        Association between opioid prescribing patterns and opioid overdose-related deaths.
        JAMA. 2011; 305: 1315-1321
        • Brady J.E.
        • Wunsch H.
        • DiMaggio C.
        • Lang B.H.
        • Giglio J.
        • Li G.
        Prescription drug monitoring and dispensing of prescription opioids.
        Public Health Rep. 2014; 129: 139-147
        • Butler M.M.
        • Ancona R.M.
        • Beauchamp G.A.
        • Yamin C.K.
        • Winstanley E.L.
        • Hart K.W.
        • Ruffner A.H.
        • Ryan S.W.
        • Ryan R.J.
        • Lindsell C.J.
        • Lyons M.S.
        Emergency department prescription opioids as an initial exposure preceding addiction.
        Ann Emerg Med. 2016; 68: 202-208
        • Cantrill S.V.
        • Brown M.D.
        • Carlisle R.J.
        • Delaney K.A.
        • Hays D.P.
        • Nelson L.S.
        • O'Connor R.E.
        • Papa A.
        • Sporer K.A.
        • Todd K.H.
        • Whitson R.R.
        • American College of Emergency Physicians Opioid Guideline Writing Panel
        Clinical policy: Critical issues in the prescribing of opioids for adult patients in the emergency department.
        Ann Emerg Med. 2012; 60: 499-525
        • Compton W.M.
        • Boyle M.
        • Wargo E.
        Prescription opioid abuse: Problems and responses.
        Prev Med. 2015; 80: 5-9
        • Compton W.M.
        • Jones C.M.
        • Baldwin G.T.
        Relationship between nonmedical prescription-opioid use and heroin use.
        N Engl J Med. 2016; 374: 154-163
        • Department of Health and Human Services, and Assistant Secretary for Planning and Evaluation
        Opioid abuse in the U.S. and HHS actions to address opioid-drug related overdoses and death.
        (Available at:) (Accessed November 11, 2017)
        • Dowell D.
        • Haegerich T.M.
        • Chou R.
        CDC guideline for prescribing opioids for chronic pain—United States, 2016.
        MMWR Recomm Rep. 2016; 65: 1-49
        • Ingram D.D.
        • Franco S.J.
        2013 NCHS urban–rural classification scheme for counties. National Center for Health Statistics.
        Vital Health Stat 2. 2014; : 1-73
        • Jones C.M.
        • Lurie P.
        • Woodcock J.
        Addressing prescription opioid overdose: Data support a comprehensive policy approach.
        JAMA. 2014; 312: 1733-1734
        • National Center for Health Statistics
        Multiple Cause of Death 1999–2015 on CDC WONDER Online Database.
        Centers for Disease Control and Prevention, Atlanta, GA2017
        • Patrick S.W.
        • Fry C.E.
        • Jones T.F.
        • Buntin M.B.
        Implementation of prescription drug monitoring programs associated with reductions in opioid-related death rates.
        Health Aff (Millwood). 2016; 35: 1324-1332
        • Paulozzi L.J.
        • Kilbourne E.M.
        • Desai H.A.
        Prescription drug monitoring programs and death rates from drug overdose.
        Pain Med. 2011; 12: 747-754
        • Pletcher M.J.
        • Kertesz S.G.
        • Kohn M.A.
        • Gonzales R.
        Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments.
        JAMA. 2008; 299: 70-78
        • Rui P.
        • Kang K.
        National hospital ambulatory medical care survey: 2014 emergency department summary tables.
        (Available at:) (Accessed November 11, 2017)
        • Rutkow L.
        • Chang H.Y.
        • Daubresse M.
        • Webster D.W.
        • Stuart E.A.
        • Alexander G.C.
        Effect of Florida's prescription drug monitoring program and pill mill laws on opioid prescribing and use.
        JAMA Intern Med. 2015; 175: 1642-1649
        • Shahian D.M.
        • Nordberg P.
        • Meyer G.S.
        • Blanchfield B.B.
        • Mort E.A.
        • Torchiana D.F.
        • Normand S.L.
        Contemporary performance of U.S. teaching and nonteaching hospitals.
        Acad Med. 2012; 87: 701-708
      1. The DAWN Report: Highlights of the 2011 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, Rockville, MD2013
        • Todd K.H.
        • Ducharme J.
        • Choiniere M.
        • Crandall C.S.
        • Fosnocht D.E.
        • Homel P.
        • Tanabe P.
        • PEMI Study Group
        Pain in the emergency department: Results of the Pain and Emergency Medicine Initiative (PEMI) multicenter study.
        J Pain. 2007; 8: 460-466
        • Weiner S.G.
        • Baker O.
        • Poon S.J.
        • Rodgers A.F.
        • Garner C.
        • Nelson L.S.
        • Schuur J.D.
        The effect of opioid prescribing guidelines on prescriptions by emergency physicians in Ohio.
        Ann Emerg Med. 2017; 70 (e1): 799-808