Number Of Opioid Prescriptions Research Articles

Outcomes From a Decade of Risk Evaluation Mitigation Strategies and Safe Opioid Prescribing Education

Opioid overdose deaths are a major public health problem. Deaths from illicit drug use remain high, but mitigation strategies that provide safety measures and guidance to prescribers have resulted in a 50% decrease in the number of opioid prescriptions. The importance and impact of a decade-long process to develop and refine safety mechanisms and implement treatment guidelines are helping to break the cycle of prescription overdose deaths. The major mitigation outcomes as well as remaining barriers that have shifted prescription use to illicit use resulting in ongoing high numbers of overdose deaths are discussed.

Assessment and Visualization of the Physician Role in the Opioid Crisis in New Hampshire Utilizing Geographic Information Systems

This project utilizes GIS to map data pertaining to the physician role in combating this epidemic. There is a positive correlation between the number of opioid prescribers per county and the number of opioid prescriptions

Changes in opioid prescribing in veterans with headache during the COVID-19 pandemic: A regression discontinuity in time analysis.

To determine changes in opioid prescribing among veterans with headaches during the coronavirus disease of 2019 (COVID-19) pandemic by comparing the stay-at-home phase (March 15 to May 30, 2020) and the reopening phase (May 31 to December 31, 2020). Opioid prescribing for chronic pain has declined substantially since 2016; however, changes in opioid prescribing during the COVID-19 pandemic among veterans with headaches remain unknown. This retrospective cohort study utilized regression discontinuity in time and difference-in-differences design to analyze veterans aged ≥18 years with a previous diagnosis of headache disorders and an outpatient visit to the Veterans Health Administration (VHA) during the study period. We measured the weekly number of opioid prescriptions, the number of days supplied, the daily dose in morphine milligram equivalents (MMEs), and the number of prescriptions with ≥50 morphine equivalent daily doses (MEDD). A total of 81,376 veterans were analyzed with 589,950 opioid prescriptions. The mean (SD) age was 51.6 (13.5) years, 57,242 (70.3%) were male, and 53,464 (65.7%) were White. During the pre-pandemic period, 323.6 opioid prescriptions (interquartile range 292.1-325.8) were dispensed weekly, with an median (IQR) of 24.1 (24.0-24.4) days supplied and 31.8 (31.2-32.5) MMEs. Transition to stay-at-home was associated with a 7.7% decrease in the number of prescriptions (incidence rate ratio [IRR] 1.077, 95% confidence interval [CI] 0.866-0.984) and a 9.8% increase in days supplied (IRR 1.098, 95% CI 1.078-1.119). Similar trends were observed during the reopening period. Subgroup analysis among veterans on long-term opioid therapy also revealed 1.7% and 1.4% increases in days supplied during the stay-at-home (IRR 1.017, 95% CI 1.009-1.025) and reopening phase (IRR 1.014, 95% CI 1.007-1.021); however, changes in the total number of prescriptions, MME/day, or the number of prescriptions >50 MEDD were insignificant. Prescription opioid access was maintained for veterans within VHA during the pandemic. The de-escalation of opioid prescribing observed prior to the pandemic was not seen in our study.

Effect of a targeted quality improvement education on opioid prescribing

BackgroundThe opioid epidemic is a serious social, economic and public health problem. This study was designed to evaluate the effectiveness of individual institutional opioid prescriber training on prescriber adherence to...

Real-World Observational Evaluation of Common Interventions to Reduce Emergency Department Prescribing of Opioid Medications.

Prior work on opioid prescribing has examined dosing defaults, interruptive alerts, or "harder" stops such as electronic prescribing of controlled substances (EPCS), which has become increasingly required by state policy. Given that real-world opioid stewardship policies are concurrent and overlapping, the authors examined the effect of such policies on emergency department (ED) opioid prescriptions. The researchers performed observational analysis of all ED visits discharged between December 17, 2016, and December 31, 2019, across seven EDs of a hospital system. Four interventions were examined in chronological order, with each successive intervention added on top of all previous interventions: 12-pill prescription default, EPCS, electronic health record (EHR) pop-up alert, and 8-pill prescription default. The primary outcome was opioid prescribing, which was described as number of opioid prescriptions per 100 discharged ED visits and modeled as a binary outcome for each visit. Secondary outcomes included prescription morphine milligram equivalents (MME) and non-opioid analgesia prescriptions. A total of 775,692 ED visits were included in the study. Compared to the preintervention period, cumulative reductions in opioid prescribing were seen with incremental interventions, including after adding a 12-pill default (odds ratio [OR] 0.88, 95% confidence interval [CI] 0.82-0.94), after adding EPCS (OR 0.7, 95% CI 0.63-0.77), after adding pop-up alerts (OR 0.67, 95% CI 0.63-0.71), and after adding an 8-pill default (OR 0.61, 95% CI 0.58-0.65). EHR-implemented solutions such as EPCS, pop-up alerts, and pill defaults had varying but significant effects on reducing ED opioid prescribing. Policy makers and quality improvement leaders might achieve sustainable improvements in opioid stewardship while balancing clinician alert fatigue through policy efforts promoting implementation of EPCS and default dispense quantities.

Predicting benzodiazepine prescriptions: A proof-of-concept machine learning approach.

Benzodiazepines are the most commonly prescribed psychotropic medications, but they may place users at risk of serious adverse effects. Developing a method to predict benzodiazepine prescriptions could assist in prevention efforts. The present study applies machine learning methods to de-identified electronic health record data, in order to develop algorithms for predicting benzodiazepine prescription receipt (yes/no) and number of benzodiazepine prescriptions (0, 1, 2+) at a given encounter. Support-vector machine (SVM) and random forest (RF) approaches were applied to outpatient psychiatry, family medicine, and geriatric medicine data from a large academic medical center. The training sample comprised encounters taking place between January 2020 and December 2021 (N = 204,723 encounters); the testing sample comprised data from encounters taking place between January and March 2022 (N = 28,631 encounters). The following empirically-supported features were evaluated: anxiety and sleep disorders (primary anxiety diagnosis, any anxiety diagnosis, primary sleep diagnosis, any sleep diagnosis), demographic characteristics (age, gender, race), medications (opioid prescription, number of opioid prescriptions, antidepressant prescription, antipsychotic prescription), other clinical variables (mood disorder, psychotic disorder, neurocognitive disorder, prescriber specialty), and insurance status (any insurance, type of insurance). We took a step-wise approach to developing a prediction model, wherein Model 1 included only anxiety and sleep diagnoses, and each subsequent model included an additional group of features. For predicting benzodiazepine prescription receipt (yes/no), all models showed good to excellent overall accuracy and area under the receiver operating characteristic curve (AUC) for both SVM (Accuracy = 0.868-0.883; AUC = 0.864-0.924) and RF (Accuracy = 0.860-0.887; AUC = 0.877-0.953). Overall accuracy was also high for predicting number of benzodiazepine prescriptions (0, 1, 2+) for both SVM (Accuracy = 0.861-0.877) and RF (Accuracy = 0.846-0.878). Results suggest SVM and RF algorithms can accurately classify individuals who receive a benzodiazepine prescription and can separate patients by the number of benzodiazepine prescriptions received at a given encounter. If replicated, these predictive models could inform system-level interventions to reduce the public health burden of benzodiazepines.

Opioid prescribing among aged care residents during the first year of the COVID-19 pandemic: an analysis using general practice health records in Australia

BackgroundOpioid use is common among adults 65 years and older, while long-term use of opioids remains controversial and poses risks of drug dependence and other adverse events. The acute disease caused by the SARS-CoV-2 (COVID-19) pandemic has created new challenges and barriers to healthcare access, particularly for long-term care residents. Australia had a relatively low incidence and deaths due to COVID-19 during the first year of the pandemic compared to most OECD countries. In this context, we examined opioid prescribing rates and their dosage in residential aged care facilities (RACFs) before (2019) and during the COVID-19 pandemic (2020) from March to December in Australia.MethodsWe conducted a retrospective cohort analysis using general practice electronic health records. This includes 17,304 RACF residents aged 65 years and over from 361 general practices in New South Wales and Victoria. Number of opioid prescriptions and percentage of opioids over 50 mg/day of oral morphine equivalent (OME) were described. Multivariate generalized estimating equations were applied to estimate odds ratios [aORs (95% confidence intervals)] for 1) opioids prescribed per consultation and 2) prescription opioids over 50 mg/day OME.ResultsIn 2020 among 11,154 residents, 22.8% of 90,897 total prescriptions were opioids, and of the opioids, 11.3% were over 50 mg/day OME. In 2019 among 10,506 residents, 18.8% of 71,829 total prescriptions were opioids, of which 10.3% were over 50 mg/day OME. Year [2020 vs. 2019: aOR (95% CI):1.50 (1.44, 1.56); 1.29 (1.15, 1.46)] and regionality [rural/regional vs. metropolitan: 1.37 (1.26, 1.49); 1.40 (1.14, 1.71)] were associated with higher odds of prescription opioids and OME > 50 mg/day, respectively. Similar results were found when limited to the same residents (n = 7,340) recorded in both years.ConclusionsHigher prescription rates of opioids were observed during the COVID-19 pandemic in 2020 than in 2019 in Australian RACFs. The higher odds of prescription opioids and higher dosing in rural/regional than metropolitan areas indicate a widening of the gap in the quality of pain management during the pandemic. Our findings contribute to the limited data that indicate increased opioid prescriptions in long-term care facilities, which is likely to continue while COVID-19 pandemic restrictions remain.

Machine Learning Model Identifies Preoperative Opioid Use, Male Sex, and Elevated Body Mass Index as Predictive Factors for Prolonged Opioid Consumption Following Arthroscopic Meniscal Surgery

To develop a predictive machine learning model to identify prognostic factors for continued opioid prescriptions after arthroscopic meniscus surgery. Patients undergoing arthroscopic meniscal surgery, such as meniscus debridement, repair, or revision at a single institution from 2013 to 2017 were retrospectively followed up to 1 year postoperatively. Procedural details were recorded, including concomitant procedures, primary versus revision, and whether a partial debridement or a repair was performed. Intraoperative arthritis severity was measured using the Outerbridge Classification. The number of opioid prescriptions in each month was recorded. Primary analysis used was the multivariate Cox-Regression model. We then created a naïve Bayesian model, a machine learning classifier that uses Bayes' theorem with an assumption of independence between variables. A total of 581 patients were reviewed. Postoperative opioid refills occurred in 98 patients (16.9%). Multivariate logistic modeling was used; independent risk factors for opioid refills included male sex, larger body mass index, and chronic preoperative opioid use, while meniscus resection demonstrated decreased likelihood of refills. Concomitant procedures, revision procedures, and presence of arthritis graded by the Outerbridge classification were not significant predictors of postoperative opioid refills. The naïve Bayesian model for extended postoperative opioid use demonstrated good fit with our cohort with an area under the curve of 0.79, sensitivity of 94.5%, positive predictive value (PPV) of 83%, and a detection rate of 78.2%. The two most important features in the model were preoperative opioid use and male sex. After arthroscopic meniscus surgery, preoperative opioid consumption and male sex were the most significant predictors for sustained opioid use beyond 1 month postoperatively. Intraoperative arthritis was not an independent risk factor for continued refills. A machine learning algorithm performed with high accuracy, although with a high false positive rate, to function as a screening tool to identify patients filling additional narcotic prescriptions after surgery. III, retrospective comparative study.

Prediction of High Acute Care Utilization in Children with Sickle Cell Disease

Background: A small percentage of patients with sickle cell disease (SCD) account for a high percentage of acute care utilization and painful vaso-occlusive episodes (VOEs) requiring hospitalization. Chronic pain may develop in patients with SCD who experience frequent VOEs. Little is known about the mechanisms mediating the development of chronic pain in SCD, and there are no reliable clinical predictors for the development of a chronic pain phenotype. We aimed to determine the factors associated with the development of chronic pain phenotype characterized by high acute care utilization, in children and adolescents with SCD. Methods: We performed a single-institution, retrospective case-control study of all patients aged 10-25 years old who received SCD care at our institution from 2016-2020. Patients were identified using ICD-10 codes for SCD. For patients meeting inclusion/exclusion criteria, we extracted demographic, laboratory, and opioid prescription data. ED visits and hospitalization encounters during which parenteral opioids were administered were identified in the electronic medical record. Distribution of acute care encounters among all included patients was used to establish cases who met criteria for high acute care utilization, defined as > 85th percentile for all patients. Laboratory data were collected from the index year, defined as the first year a case met criteria for high acute care utilization, or from the matched year within 1-2 year window, for controls, as well as from the year prior. Chi-square and student t test were used to compare categorical and continuous variables, respectively, between cases and controls using SAS (Cary, NC). ROC curves were created to determine the discriminatory ability of using opioid prescription data to identify patients meeting criteria for high acute care utilization. Results: A total of 200 patients with SCD (all genotypes) met inclusion/exclusion criteria for the study. The 85thpercentile cut point corresponded to ≥4 acute care encounters in one year. Using this definition, 36/200 (18%) patients who were considered "high acute care utilizers" and had ≥4 acute care visits during any 1-year period during 2016-2020 were chosen as cases. Matching 2:1 by genotype and calendar year, 72 "low-utilizers" were randomly selected as controls among the 127 patients who had ≤1 acute care visit during each year of inclusion. Age, sex, and hydroxyurea use did not differ among cases vs controls. We found a higher proportion of patients with Medicaid insurance (83% vs 62%, p=0.03), as well as asthma (33% vs 11%, p=0.008) and anxiety or depression (39% vs 2%, p<0.001), among cases vs controls. Steady-state laboratory variables did not differ significantly among cases vs controls. Total opioid prescriptions were significantly higher in both index year [7.7 (95% CI: 5.2-10.2) vs 1.3 (0.9-1.7), p<0.001] and in the year prior [4.6 (95% CI: 1.9-7.2) vs 1.0 (0.7-1.3), p=0.01] among cases vs controls. Total morphine equivalents during the index year utilizers [3540 (95% CI: 1010-6060) vs 554 (355-753), p=0.02] and in the year prior [1386 mg (95% CI: 597-2170) vs 448 mg (249-648), p=0.01] were significantly higher among high acute care utilizers. ROC curves for average total opioid prescriptions and total morphine equivalents prescribed in the year prior to meeting criteria for high acute care utilization demonstrated AUCs of 0.80 and 0.81, respectively. Using these ROC curves, a cutpoint of ≥2 opioid prescriptions in the prior year was associated with a maximal sensitivity of 75% and a specificity of 76%. A cutpoint of ≥400mg of total morphine equivalents in the year prior was associated with a maximal sensitivity of 81% and a maximal specificity of 71%. Conclusions: We found no relationship between laboratory variables and high acute care utilization in children and young adults with SCD. Demographic and clinical factors associated with high acute care utilization include Medicaid insurance status, asthma and mood disorders as well as number of opioid prescriptions in the year prior to meeting our criterion for high acute care utilization. Future studies should be conducted to prospectively identify predictors of high acute care utilization and the development of chronic pain in SCD. The role of opioids for the treatment of chronic pain in SCD and the relationship of opioid to the development of high acute care utilization and chronic pain should also be further studied.

State Member Board Briefs

The number of opioid prescriptions in Alabama have fallen for an eighth consecutive year, according to a report released by the American Medical Association on September 8, 2022. Additional data released in the report also showed that: Opioid prescriptions in Alabama decreased 41.6% from 2012–2021. From 2020–2021, opioid prescriptions in the state declined 1.6%, marking the eighth consecutive year the number of opioid prescriptions in Alabama has dropped.The dosage strength of opioid prescriptions fell 52.7% from 2012–2021 and dropped 6.5% between 2020–2021.Prescriptions of naloxone to treat patients at risk of an opioid overdose rose 851% between 2012–2021 and 35.4% from 2020–2021.Physicians and other healthcare professionals accessed the state’s Prescription Drug Monitoring Program more than 5.5 million times in 2021, an increase of three percent from 2020. Healthcare providers who dispense opioids in Alabama must report the information to the Prescription Drug Monitoring Program to help physicians detect the abuse and misuse of prescriptions.The Medical Association of the State of Alabama was one of the first medical associations in the country to offer a continuing education course to train physicians on safely and effectively prescribing opioids. Since 2009, more than 8,000 prescribers in Alabama have completed the course.“Alabama physicians are advancing the fight against the opioid crisis by continuing to reduce the number and potency of prescribed opioids in our state, and by furthering our education on opioids,” said Dr. Julia Boothe, President of the Medical Association of the State of Alabama. “While we are making good progress in these areas under a physician’s control, Alabama is in a worsening overdose epidemic due primarily to illicitly manufactured fentanyl, which is found in more than 75% of counterfeit pills and other substances. No community is safe from this poison.”Source: Alabama State Medical Board of Medical Examiners and Medical Licensure Commission Announcement, September 8, 2022The Medical Board of California recently took a significant step in updating its Guidelines for Prescribing Controlled Substances, last updated in November 2014. The Board released a draft of its updated guidelines on its website and solicited input from stakeholders at a July 14, 2022, Interested Parties Meeting.After considering all the feedback and incorporating proposed changes from stakeholders where appropriate, the task force and Board staff plan to present the revised guidelines to the Board at a future Board meeting.The Board’s revised guidelines now place the decision of what to prescribe to patients solely on the physician and the needs of the patient. The guidelines highly encourage physicians to document their prescription decisions in the patient’s medical record and keep the records up to date.The guidelines also incorporate legislation such as the mandatory consultation of Controlled Substance Utilization Review and Evaluation System (CURES) before prescribing schedule II–IV controlled substances, and the requirement to prescribe all controlled substances, with certain exemptions, electronically.Source: Medical Board of California News, Volume 161, Second Quarter EditionOregon Psilocybin Services (OPS) is a new section housed within the Oregon Health Authority (OHA) Public Health Division’s Center for Health Protection. OPS will implement Ballot Measure 109, which was passed in November 2020 and directs the OHA to license and regulate the manufacturing, transportation, delivery, sale, and purchase of psilocybin products, as well as the provision of psilocybin services.OPS will begin accepting applications for licensure in early 2023. Until then, the section is in a development period, working to build the nation’s first regulatory framework for psilocybin services.Source: Oregon Health Authority websiteVirginia Governor Glenn Youngkin has appointed 5 new members to the Board of Medicine. They are Peter Apel, MD (6th Congressional District), Randy Clements, DPM (Roanoke), Hazem Elariny, MD (8th Congressional District), William Hutchens, MD (11th Congressional District), and Krishna Madiraju, MD (10th Congressional District). The 5 members whose terms have expired and have rotated off the Board are Jim Arnold, DPM, Amanda Barner, MD, Milly Rambhia, MD, Brenda Stokes, MD and Khalique Zahir, MD.The Virginia Board of Medicine has selected Blanton Marchese, Citizen member from Midlothian as President, David Archer, MD, OB/GYN, from Norfolk as Vice-President, and Alvin Edwards, PhD, from Charlottesville as Secretary-Treasurer.Source: Virginia Board of Medicine Board Briefs #94, April 2022

Opioid prescribing by oral and maxillofacial surgeons in the United States, 2016-2019.

To describe opioid prescribing trends among oral and maxillofacial surgeons (OMFS). Prescriptions by OMFS were identified from IQVIA Longitudinal Prescription Dataset, 2016-2019. OMFS-based, patient-based and population-based prescribing rates and changes in high-risk opioid prescribing were calculated annually. We used linear regression to describe trends. There were 13.9million opioid prescriptions among 12.5million patients (627 prescriptions/OMFS/year). Hydrocodone and oxycodone decreased by 20.9% and 39.2% (p < 0.05), while tramadol and codeine increased by 24.3% and 6.1% (p < 0.05), respectively. Opioid prescribing rates significantly decreased by 27 prescriptions/OMFS/year, 18.6 patients/OMFS/year and by 0.9 prescriptions/100,000 population/year (p < 0.05 for all). From 2016 to 2019, the proportion of opioids >3 days decreased by 54.2% (p < 0.05) and prescriptions ≥50 MME/day decreased by 66.3% (p < 0.05). Although the number of opioid prescriptions by OMFS decreased in most states, 12% of states experienced increases. Opioid prescribing, especially high-risk prescribing, by OMFS has decreased. However, targeted interventions are warranted in some areas.

Treatment with opioids in patients with locally advanced or metastatic urothelial carcinoma and matched non-cancer controls.

Locally advanced or metastatic urothelial carcinoma (la/mUC) is an aggressive disease with a poor long-term survival. While patients frequently report pain, there are limited data on the patient experience with pain and pain medication use. This study used real-world data to quantify treatment with opioids, as a proxy for pain, in patients with la/mUC compared with matched non-cancer controls. This was a retrospective claims analysis, using the IBM® MarketScan® databases, of adults diagnosed with urothelial carcinoma and initiating ≥1 la/mUC therapy between May 2016 and June 2019. Index date was date of first systemic therapy claim for la/mUC; baseline was the 6 months pre-index; follow-up was from index until disenrollment or study end. Proportion with treatment with opioids, number of opioid prescriptions, and daily morphine-equivalent dose (MEQ; in morphine milligram equivalents/day) in patients with la/mUC and matched non-cancer controls from the same databases were assessed. We identified 1293 patients with la/mUC and matched 1:3 with 3862 non-cancer controls. Mean (SD) follow-up was 1.26 (0.74) years in patients with la/mUC and 1.29 (0.72) years in controls. A greater proportion of patients with la/mUC, compared with controls, used opioids during both baseline (63.6% vs. 19.4%) and follow-up (61.4% vs. 27.9%). Among those who used opioids, mean monthly prescriptions (number of medications claims/patient/month) were 0.55 both in patients with la/mUC and controls during baseline, and 0.49 and 0.39, respectively, at follow-up. Daily MEQ among those who used opioids was 53.6 and 45.7 during baseline, and 74.7 and 40.8 at follow-up, in patients with la/mUC and controls, respectively. In patients with la/mUC, mean opioid prescriptions and daily MEQ increased during later lines of therapy. In patients with la/mUC, pain requiring opioids is common at diagnosis, worsens as the patient progresses, and is consistently higher than in matched controls. Improvement in disease control with more effective therapies may reduce cancer pain in this population.

Opioid Use at End-Of-Life Among Nova Scotia Patients With Cancer.

Purpose: To determine the factors associated with opioid analgesic prescriptions as measured by community pharmacy dispensations to all Nova Scotia (NS) patients with cancer at end-of-life from 2005 to 2009. Methods: The NS Cancer Registry and the NS Prescription Monitoring Program (NSPMP) were used to link Nova Scotians who had a cancer diagnosis and received a prescription for opioids in their last year of life (n = 6,186) from 2005 to 2009. The association of factors with opioid dispensations at end-of-life were determined (e.g., patient demographics, type of prescriber, type of cancer, and opioid type, formulation, and dose). Results: Almost 54% (n = 6,186) of the end-of-life study population with cancer (n = 11,498) was linked to the NSPMP and therefore dispensed opioids. Most prescriptions were written by general practitioners (89%) and were for strong opioids (81%). Immediate-release formulations were more common than modified-release formulations. Although the annual average parenteral morphine equivalents (MEQ) did not change during the study period, the number of opioid prescriptions per patient per year increased from 5.9 in 2006 to 7.0 in 2009 (p < 0.0001). Patients age 80 and over received the fewest prescriptions (mean 3.9/year) and the lowest opioid doses (17.0 MEQ) while patients aged 40–49 received the most prescriptions (mean 14.5/year) and the highest doses of opioid (80.2 MEQ). Conclusion: Our study examined opioid analgesic use at end-of-life in patients with cancer for a large real-world population and determined factors, trends and patterns associated with type and dose of opioid dispensed. We provide information regarding how general practitioners prescribe opioid therapy to patients at end-of-life. Our data suggest that at the time of this study, there may have been under-prescribing of opioids to patients with cancer at end-of-life. This information can be used to increase awareness among general practitioners, and to inform recommendations from professional regulatory bodies, to aid in managing pain for cancer patients at end-of-life. Future work could address how opioid prescribing has changed over time, and whether efforts to reduce opioid prescribing in response to the opioid crisis have affected patients with cancer at end-of-life in Nova Scotia.

Standardizing Opioid Prescribing in a Pediatric Hospital: A Quality Improvement Effort

Opioids are indicated for moderate-to-severe pain caused by trauma, ischemia, surgery, cancer and sickle cell disease, and vaso-occlusive episodes (SCD-VOC). There is only limited evidence regarding the appropriate number of doses to prescribe for specific indications. Therefore, we developed and implemented an opioid prescribing algorithm with dosing guidelines for specific procedures and conditions. We aimed to reach and sustain 90% compliance within 1 year of implementation. We conducted this quality improvement effort at a pediatric academic quaternary care institution. In 2018, a multidisciplinary team identified the need for a standard approach to opioid prescribing. The algorithm guides prescribers to evaluate the medical history, physical examination, red flags, pain type, and to initiate opioid-sparing interventions before prescribing opioids. Opioid prescriptions written between January 2015 and September 2020 were included. Examples from 2 hospital departments will be highlighted. Control charts for compliance with guidelines and variability in the doses prescribed are presented for selected procedures and conditions. Over 5 years, 83 037 opioid prescriptions in 53 804 unique patients were entered electronically. The encounters with ≥1 opioid prescription decreased from 48% to 25% between 2015 and 2019. Compliance with the specific guidelines increased to ∼85% for periacetabular osteotomies and SCD-VOC and close to 100% for anterior-cruciate ligament surgery. In all 3 procedures and conditions, variability in the number of doses prescribed decreased significantly. We developed an algorithm, guidelines, and a process for improvement. The number of opioid prescriptions and variability in opioid prescribing decreased. Future evaluation of specific initiatives within departments is needed.

Safe opioid prescribing: a community-based approach

ABSTRACT Substance use disorder (SUD) is a multifactorial issue that leads to over 67,000 overdose deaths annually, with the most recent data identifying 98,000 deaths in 2020 according to the Center for Disease Control (CDC). In 2018, Staten Island, with a population of approximately 500,000, was identified as the epicenter of the opioid epidemic in New York City. One specific area of concern during an analysis of potential causes was that the number of opioid prescriptions per capita, dosing, and duration on Staten Island far exceeded city and state norms. A committee of prescribers was formed to create safe prescribing guidelines. The recommendations included prescribing standards, education on non-opioid alternatives, safe disposal, and screening for substance misuse. Community-wide attention was brought to the topic via media campaigns, patient literature, and the involvement of multiple community stakeholders. After the education of over 500 prescribers, the postintervention period resulted in significant and sustained reductions in all indicators. The greatest improvements were in total prescriptions filled, which were reduced by over 12,000 prescriptions or 31% (p-value <.00001), and in recipients of opioid prescriptions, which reduced by over 1,700 individuals or 22% (p-value <.00001). Continuing education, recruitment of new practitioners, and on-line education was instituted to ensure sustainability.

Mortality by opioid poisoning in children and teenagers and opioid prescriptions

BackgroundNo comparisons between mortality from opioids in children and teenagers and opioid prescription patterns have been made in England.AimTo investigate if an association exists between mortality rates from opioid poisoning in persons aged 19 years old and under and community opioid prescription in England.MethodsA retrospective analysis was undertaken for 2016 to 2019, comparing community opioid prescriptions and mortality rates from opioid poisoning.ResultsThe number of opioid prescriptions decreased over the study period (− 2.4%, p < 0.001). Most deaths due to opioid poisoning in children and teenagers were seen in those under one year old and those aged between 15 and 19 years old (Kruskal-Wallis: p = 0.12; Dunn’s test: p = 0.01). Deaths in all age ranges did not change significantly (Poisson Regression Analysis: p > 0.05).ConclusionDespite the reduction in community opioid prescriptions, there was no decrease in the number of deaths in children and teenagers due to opioid poisoning.

Geographic variation in the use of triptans and opioids for the acute treatment of migraine attacks.

To assess the geographic variations in triptan and opioid prescribing patterns for patients with migraine. Numerous guidelines recommend triptans as the standard of care for migraine attacks, yet opioids are still widely used for migraine treatment. Variation in the use of opioids and triptans for the treatment of migraine by geographic location is not well known. Using a US claims database, we conducted a retrospective cohort study of adults diagnosed with migraine between 2016 and 2018. We used a 12-month follow-up period to assess triptan and opioid utilization, stratified by the nine Census Bureau-designated divisions. To examine the geographic factors that affect triptan and opioid use among patients, we conducted two sets of multivariable analyses. First, we analyzed the odds of a patient being a triptan or opioid user in the follow-up period, defined as ≥1 triptan or opioid claim. We then analyzed the medication use rate among triptan or opioid users. Overall, we had a final study population of 113,921 patients. In the follow-up period, 52.9% (60,247/113,921) [range: 48.0%-56.3%] of patients were triptan users and 41.0% (46,708/113,921) [range: 28.9%-48.4%] of patients were opioid users with significant differences across census divisions (p<0.001). Triptan users had a mean (SD) of 4.8 (4.7) triptan claims annually with no significant differences across divisions (p=0.188). Opioid users had a mean (SD) of 5.4 (6.8) opioid claims annually with significant differences across divisions (p<0.001). The observed variation in opioid use stemmed from the proportion of patients using opioids in each region and not from the number of opioid prescriptions per user. There was a significant geographic variation in the use of opioids and to a lesser degree the use of triptans. The widespread use of opioids and the large variation in use other than triptans as the standard of care suggest that improvements could be made in the acute treatment of migraine attacks.

Older, Male Orthopaedic Surgeons From Southern Geographies Prescribe Higher Doses of Post-Operative Narcotics Than do their Counterparts: A Medicare Population Study

PurposeWe wanted to evaluate opioid prescribing patterns among orthopaedic surgeons and to identify demographics that may be associated with more extensive opioid prescribing habits that could be candidates for targeted education policies.MethodsMedicare Part D prescriber and prescription information for the most recent available year, 2017, was accessed via a publicly available database offered by the Centers for Medicare and Medicaid. Number of total prescriptions, number of opioid prescriptions, and the total days’ supply of opioids prescribed were analyzed for each of 19,219 orthopaedic surgeons. Demographics and board certification status were also recorded.ResultsOrthopaedic surgeons who wrote the most opioid prescriptions (>400 per year) also wrote the longest prescription durations (14.1 days/prescription, P < .05 for all comparisons). Surgeons with more than 30 years of experience wrote the longest prescriptions (11.8 days/prescription; P < .001). Male surgeons wrote more opioid prescriptions than female surgeons (151 vs 95, respectively; P < .001). However, female surgeons wrote longer prescriptions than male surgeons (7.5 days/prescription vs 6.1 days/prescription, respectively; P = .01). Surgeons from southern states wrote the most opioid prescriptions (1,386,897) and the longest prescriptions, with an average of 13.0 days per prescription, whereas western states wrote the shortest prescriptions at 10.4 days per prescription (P = .004).ConclusionThere are demographic correlations between orthopaedic surgeons and opioid prescribing patterns. In particular, male, older southern surgeons prescribe the highest volumes of opioids. This provides an opportunity for targeted education versus overarching, general policies. Potential directions for future investigation can focus on assessing recent trends in opioid prescriptions among orthopaedic providers.Level of EvidenceLevel III, retrospective cohort study.

Practitioner counseling associated with improved opioid disposal among families of postoperative pediatric patients

Death from opioid-related overdose has doubled in recent years. Interestingly, there has been a similar increase in the number of opioid prescriptions. Medical providers, unfortunately, have contributed towards this rise in prescriptions. To combat the opioid epidemic, numerous efforts have been made to focus on the medical field and its role in the opioid epidemic. Proposed solutions for reduction of circulating opioids have included such measures as education, monitoring programs, alternative pain management strategies, and improved opioid disposal. We aimed to assess if counseling is associated with proper opioid disposal among families of post-operative pediatric patients. We conducted a cross-sectional, convenience sample study of families of post-surgical, pediatric patients at a single academic institution. Participants completed a survey during their postoperative visit assessing opioid requirements, storage and disposal during and after the postoperative period, and if they were counseled by any medical professional on proper disposal methods. We used multivariable logistic regression to evaluate the association between the independent variables and the primary outcome. We enrolled 180 participants, mean age of 8 years. Thirty-four percent reported having no opioid medication remaining at follow up because the medication was either consumed or the prescription was not filled. Sixty-six percent had leftover medication at the time of follow up. Sixty-six percent of participants knew the proper opioid disposal methods. However, only 22% of patients with leftover medication properly disposed of the medication. Patients who were counseled about proper opioid disposal were 3 times more likely to practice proper disposal practices than those who were not (p<0.01). Our study uniquely look at opioid consumption, disposal rates, and the effect of counseling in a diverse post-surgical pediatric population. Our findings confirm similar observations in the literature with regards to low opioid consumption, but in a larger, more surgically diverse cohort with a 100% response rate. Limitations included a lack of demographic diversity and lack of data measuring the impact of timing or frequency of counseling on opioid disposal practices. Further research goals would be to evaluate the effectiveness of counseling on proper opioid disposal, and the influence of timing and various counseling methods. Most patients do not use all of their opioid medication prescription. Proper opioid disposal counseling by a medical professional may play an important role in adherence to recommended opioid disposal practices.

Opioid use in locally advanced or metastatic urothelial carcinoma patients and matched non-cancer controls.

e16517 Background: There are currently no published data on the patient experience with pain and pain medication use among the locally advanced or metastatic urothelial carcinoma (la/mUC) population. In this study, we quantified opioid use, as a proxy for pain, in patients with la/mUC and in matched non-cancer controls, using real-world data. Methods: We performed a retrospective claims analysis of adults diagnosed with UC who initiated ≥1 la/mUC therapy between 5/2016-6/2019 using the IBM MarketScan databases. Non-cancer controls were identified in 2 steps: 1) exact match on age/gender at index, 2) nearest neighbor propensity score matching (1:3 ratio) based on age, gender, region, insurance type, index year, enrollment time, and major comorbidities. Index was the date of first la/mUC therapy; index for controls was aligned to claims activity for matched patients with la/mUC. Baseline was the 6 months pre-index; follow-up was from index until disenrollment, death or study end (12/2019). Analyses examined the proportion of opioid users, number of opioid prescriptions, and daily morphine equivalent dose (MEQ). Results: A total of 1,293 patients with la/mUC and 3862 controls were included; mean (standard deviation [SD]) age at index was 64.1 (11.9) years for the la/mUC cohort and 64.8 (12.0) for controls, and most were male (60.2% and 61.3%, respectively). Mean (SD) follow-up was 15.1 (8.9) and 15.5 (8.6) months, respectively. A higher proportion of patients with la/mUC used opioids than controls during both baseline and follow-up (Table). Among opioid users, trends in opioid use were similar between the cohorts during baseline, with differences during follow-up (Table). At baseline, 63.6% (n=822) of patients with la/mUC had ≥1 opioid prescription which decreased during first-line (1L) treatment to 38.8% (n=502) and subsequently increased to 47.0% (n=159 of 338) during second-line (2L) treatment. The mean (SD) number of opioid prescriptions also increased during later therapy lines (1L: 0.92 [0.99], 2L: 1.37 [1.24]) along with increases in mean (SD) daily MEQ (1L: 69.8 [274], 2L: 133 [586]). Conclusions: This study underscores the impact of pain among patients with la/mUC, which is common at diagnosis, higher than matched controls, and worsens as the patient progresses. Improved disease control with more effective therapies may reduce pain in this population. [Table: see text]