Effect of a Prescription Drug Monitoring Program on Emergency Department Opioid Prescribing

Abstract

Introduction 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. Methods We 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. Results The 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). Conclusion 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.

Decline in nontraumatic dental conditions at emergency departments in North Carolina, 2010–2020

“…Implementation of policies such as Prescription Drug Monitoring Programs has been linked to reductions in opioid use. 8 Our data suggest the hypothesis that the implementation of policy in North Carolina to address opioid prescribing may have had an impact on the relative number of hospital ED visits for NTDCs. As policy directed at opioid prescribing was implemented, the proportion of ED visits for NTDCs declined.…”

“…Naavaal et al 7 used more recent data from the 2015 to 2017 National Hospital Ambulatory Medical Care Survey and showed that dental visits were more likely to result in an opioid prescription relative to other conditions. Implementation of policies such as Prescription Drug Monitoring Programs has been linked to reductions in opioid use 8 …”

Helpful, Unnecessary, or Harmful: A Systematic Review of the Effects of Prescription Drug Monitoring Program Use on Opioid Prescriptions

“…Less comprehensive PDMP legislation (allowing clinicians access to electronic PDMP data or mandating PDMP registration but not use) did not have as strong of an effect on the number of opioids prescribed or dispensed overall. Seven studies [45][46][47][48][49][50][51] found that less comprehensive PDMP legislation was associated with a decrease in the number of opioids prescribed or dispensed overall, whereas eight found no change [44,[52][53][54][55][56][57][58]. In total, 56 articles were included in the review.…”

Surgeons’ knowledge regarding perioperative pain management in patients with opioid use disorder: a survey among 260 members of the American College of Surgeons

“…Thirty-seven states have a PDMP with 16 states mandating that it be utilized by prescribers. Studies have shown conflicting results regarding the effect that PDMP utilization has on opioid prescribing habits however, most show an overall decline in the amount of opioids prescribed in states with mandatory PMPs [ 21 – 23 ]. This survey of surgeons found that 62% of surgeons regularly use their state’s PDMP.…”