150. The effect of online prescription drug monitoring on opioid prescription habits after single level lumbar fusion

Abstract

<h3>BACKGROUND CONTEXT</h3> The United States opioid epidemic is a well-documented crisis stemming from increased prescription of narcotics, leading to widespread misuse of both prescription and nonprescription opioid pain relievers. To combat this epidemic, online prescription drug monitoring programs (PDMPs) have been implemented at the state level to track prescriptions of controlled substances and mitigate potential misuse and addiction. <h3>PURPOSE</h3> To evaluate prescription trends of opioids over time following implementation of an online PDMP in patients who underwent single-level lumbar fusion. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort analysis. <h3>PATIENT SAMPLE</h3> Patients 18 years of age or older who underwent single-level lumbar fusion for spinal stenosis, spondylolisthesis, or disc herniation. <h3>OUTCOME MEASURES</h3> Pre- and postoperative per-patient average total opioid prescriptions, prescriptions obtained by private pay, number of prescribers, number of pharmacies, number of pills/liquid doses, refills, duration of use (days), total milligram morphine equivalents (MME) per patient, preoperative opioid naivety (defined as no documented opioid prescription within one year prior to surgery), and postoperative chronic opioid use (defined as filling ten or more prescriptions, or receiving 120 or more days of opioid prescriptions, within the first year after surgery excluding the initial 90-day postoperative period). <h3>Methods</h3> Patients who underwent single-level lumbar fusion between January 1st, 2017 and December 30, 2019 were identified. Patients were placed into one of two cohorts: (1) patients whose procedure occurred during 2017, the first calendar year following implementation of the local online PDMP, and (2) patients whose procedures occurred during 2019. Opioid use data was obtained by searching for each patient in the state government's online PDMP and recording data within the year prior to and the year following the patient's procedure. <h3>Results</h3> A total of 393 patients were included in the study. One hundred seventy-two were included in the 2017 cohort, while 221 were included in the 2019 cohort. Preoperatively, the 2019 cohort obtained significantly greater average of preoperative prescription opioids via private pay compared to 2017 (0.4 ± 1.5 vs 0.1 ± 1.6, p=0.01). Postoperatively, the 2019 cohort obtained on average a greater total number of opioid prescriptions (4.0 ± 6.1 vs 2.8 ± 4.9, p=0.046), and obtained opioid prescriptions from a greater average number of prescribers (1.8 ± 1.4 vs 1.4 ± 1.6, p=0.01) and pharmacies (1.1 ± 0.7 vs 0.8 ± 0.8, p=0.001). <h3>Conclusions</h3> Despite implementation of an online PDMP, increases were found from 2017 to 2019 in per-patient preoperative prescriptions obtained by private pay as well as average total postoperative opioid prescriptions and average number of prescribers and pharmacies. While the exact effect of different strategies aimed at decreasing the misuse and abuse of narcotic medications is unclear, use of an online PDMP is not sufficient to discourage opioid use in patients undergoing single-level lumbar fusion. Future studies should determine the effect of other strategies, such as pain management modalities that do not involve opioid prescriptions, on discouraging opioid abuse. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.