95 Opioid Prescription Patterns for Burn Injury: Before and After Changes in State Law

Abstract

The rise of prescription pain medication misuse has led to policy interventions. In August of 2017, a state law was implemented in an effort to minimize the overuse of opioid pain medications. The law imposed a limit of a seven day supply with a maximum of 30 mg oral morphine equivalent daily dose (MEDD) for acute pain without requiring additional documentation. This study aimed to evaluate the impact of this law on opioid prescribing in patients with burn injury. A retrospective, observational study comparing pre- and post- implementation of the law. All patients admitted to the burn service and discharged home or who were seen in burn clinic were included if they completed at least one follow up visit. Pre-law patients were those between February 1, 2017 and July 31, 2017, while post-law patients were between October 1, 2017 and March 31, 2018. The primary outcome was time to discontinuation of opioid pain medications. Secondary outcomes included hospital length of stay, pain specialist referral at six weeks, MEDD prescribed initially and at 1 month and readmission secondary to pain. Continuous variables are reported as median (25–75% IQR) and were analyzed using the Mann-Whitney U test. Categorical variables are presented as frequency (percent) and were compared using the Chi-Square test. A total of 210 patients were included (158 outpatient and 52 inpatient), with 104 in the pre-law group and 106 post-law. The two most common etiologies were scald and flame burn with a %TBSA burn of 3.25 (2 - 6) pre-law and 3 (1.25 - 7) post-law. Time to discontinuation of all opioids was 11 days (7 - 28) in the pre-law group and 10 days (7 - 18) post (p = 0.17). Hospital length of stay was 3 days (1 -11) pre-law and 3 days (2 - 6) post-law (p = 0.92). Four patients (3.8%) were referred to a pain specialist at six weeks pre-law while no patients were referred post-law (p = 0.04). Patients were prescribed 45mg MEDD (30 - 60) pre-law and 30mg MEDD (20 - 37) post-law (p <0.001). A statistically significant decrease in MEDD was retained at one month with pre-law prescribed 45mg MEDD (30 - 60) and post-law 30mg MEDD (22 - 32) (p < 0.001). Five patients (4.8%) were readmitted for pain in the pre-law group and two patients (1.8%) post-law (p = 0.23). In patients with low %TBSA burn who are managed outpatient or with a short hospital stay, the law restricting opioid prescribing reduced total MEDD without causing an increase in readmission rates secondary to pain or an increase in length of stay. Although these finding support the success of the statute’s intent, we cannot comment on the effectiveness of pain control or patient perceptions during this period. Public policy interventions in prescription opioid management may have impact in the burn population and warrant further studies.