Guideline Cuts Inappropriate Opioid Prescription

JANUARY 29, 2016
MD Magazine Staff

With a goal of determining whether a voluntary opioid prescribing guideline reduces the proportion of patients prescribed opioids for minor and chronic conditions, del Portal and colleagues performed a retrospective chart review of the records of 13,187 adult emergency department visits between January 2012 and July 2014 for dental, neck, back, or unspecified chronic pain.

The proportion of patients receiving opioid prescriptions at discharge was compared before and after the guideline. Additionally, attending emergency physicians were surveyed on their perceptions of the impact of the guideline on prescribing patterns, patient satisfaction, and physician−patient interactions.

The investigators found a significant and sustained decrease in the rates of opioid prescriptions for each pain type, all age groups, and each of 3 categories of complaints included in the study.

Overall, the opioid prescribing rate decreased from 52.7% before the guideline to 29.8% immediately following implication and to 33.8% when assessed at 12 to 18 months later. The guideline was supported by 100% of the 31 eligible prescribing physicians who completed the survey. Most (97%) felt the guideline had facilitated discussions with patients when opioids were being withheld. Almost 75% reported encountering less hostility from patients since adoption of the guideline.

“Emergency physicians and other acute care providers can use various tools to promote the rational prescribing of dangerous opioid medications,” said del Portal. “In contrast to electronic prescription drug monitoring programs, which show promise but require significant infrastructure and regulation (and are as yet unavailable to prescribers in Pennsylvania), an easily implemented guideline empowers physicians and protects patients from the well documented dangers of opioid misuse.” 

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