Abstract
IntroductionOur goal was to determine whether implementation of a prescription drug monitoring program (PDMP) altered emergency department (ED) opioid prescription rates overall and in patients of different pain severities.MethodsWe conducted this single-center, retrospective review at an academic ED. The study examined patients discharged from the ED who received opioid prescriptions, before and after the state’s implementation of a PDMP (August 25, 2016). The monthly rate was a ratio of the patients given ≥ 1 opioid prescription to the ED patients with a numeric pain rating scale (NPRS) > 0. We performed an interrupted time series analysis on each demographic.ResultsThe overall ED opioid prescription rate decreased from 51.3% (95% confidence interval [Cl], 50.4%–52.2%) to 47.9% (95% Cl, 47.0%–48.7%). For males, this decreased from 51.1% to 46.7% (P < 0.0001), while in females it did not significantly change (51.6% to 49.7% [P = 0.0529]). For those with mild pain, the rate increased from 27.5% to 34.3% (P < 0.0001), while for those with moderate pain, it did not significantly change (42.8% to 43.5% [P = 0.5924]). For those with severe pain, the rate decreased from 66.1% to 59.6% (P < 0.0001).ConclusionWe found that PDMP implementation was associated with an overall decrease in opioid prescription rates, and that patients with mild pain were prescribed opioids more often while severe pain patients were prescribed opioids less often.
Highlights
Our goal was to determine whether implementation of a prescription drug monitoring program (PDMP) altered emergency department (ED) opioid prescription rates overall and in patients of different pain severities
We found that PDMP implementation was associated with an overall decrease in opioid prescription rates, and that patients with mild pain were prescribed opioids more often while severe pain patients were prescribed opioids less often. [West J Emerg Med. 2021;22(3)756–762.]
Among the elderly Medicare population, hospitalizations secondary to opioid overdose have quintupled from 1993 to 2012.1 some studies investigating opioid prescriptions in the emergency department (ED) show decreasing trends in recent years, new models expect the opioid crisis to worsen with the annual number of opioid overdose deaths projected to increase to 81,700 by 2025 from 33,100 in 2015.3-5 Given the number of opioids being prescribed by physicians, evidence demonstrates that prescription opioid misuse can often result in the downstream use of illicit opioids, such as heroin.[6,7,8,9,10]
Summary
In analyses of the distribution of opioid prescriptions, Effect of PDMP on Opioid Prescribing in the ED prescriptions in the ED are often carefully scrutinized.[1,11] In a study that examined the rate of opioid prescribing in a single hospital, it was found that the highest rate of opioid prescribing occurred in the ED, with an opioid prescription rate of up to more than three times that of other hospital departments.[1,12,13,14,15] Another reason that the ED serves as one of the targets for the opioid crisis is that pain is the most common chief complaint and accounts for up to 78% of visits to the ED.[16,17,18,19] With such a high rate of pain complaints in the ED leading to higher rates of opioid prescribing, prescription drug monitoring programs (PDMP) have become an important tool for emergency physicians to ensure that they are not over-prescribing opioid medications and not prescribing opioid medications to patients seeking to misuse opioids
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