Opioid Prescription in Ophthalmology and the Impact of a Decision Support Tool in Reducing Excess Dosing

Abstract

To characterize opioid prescribing in ophthalmology and to determine the impact of an alert system on opioid prescription patterns. Retrospective pre- and post-implementation study. The study population included individuals aged ≥18 years who received opioids written by ophthalmologists within a tertiary care center between January 3, 2015, and November 3, 2021, in the context of an opioid alert system. Mean morphine equivalent daily dose (MEDD) per prescription was compared before and after implementation of the opioid alert system. Additionally, mean MEDD per prescription was compared based on patient demographics and diagnoses. A total of 8014 individual patients were included in this study. The study population received a total of 9055 prescriptions, 77% of which were written for pain management related to an ophthalmic surgery. Mean MEDD per prescription decreased by 15.17 after implementation of the alert system (P < .001). A higher mean MEDD per prescription was observed among males (33.53 MEDD; P < .001). Black individuals received a higher mean MEDD per prescription (33.93 MEDD) compared with white individuals (32.80 MEDD; P=.03). Opioids written for disorders of the eyelid, lacrimal system, and orbit constituted 57.4% of total prescriptions. Prescription patterns based on patient demographics and diagnoses can provide foci for opioid prescription reform in ophthalmology. The observed decrease in opioid dosage may indicate realization of the alert system.