Oxycodone prescribing in the emergency department during the opioid crisis

Pouryahya, Pourya; Birkett, William; Meyer, Alastair; Louey, Stephen; Belhadfa, Miriam; Ferdousi, Sapphire; Imperial, Kimberly; Nguyen, Phi; Wang, Amber

doi:10.1111/1742-6723.13545

Cited by 8 publications

(11 citation statements)

References 11 publications

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“…Elements of opioid prescribing associated with an increased risk of complications include excessive initial days’ supply, high doses, concurrent prescribing of opioids and sedatives, and long-term prescribing [ 8 – 11 ]. Hospital-initiated opioids, most often for acute pain management, have been identified as a key risk for ongoing and inappropriate use [ 8 , 9 ]. Accumulating observational evidence suggests that therapeutic exposure to opioids is associated with increased likelihood of long-term use and that greater duration or intensity of initial opioid prescriptions may further elevate risk [ 10 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Policy Interventions on Oxycodone Prescribing in Queensland, Australia: An Uncontrolled Interrupted Time Series Study

2022

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Introduction Opioid prescribing rates are continuing to increase in Australia in line with prescribing rates seen internationally. Prescribing limits are one policy strategy to reduce short-term opioid prescribing, but there is limited evidence of their impact. Objective The aim of this study was to assess the impact of state and national policy interventions on changes to oxycodone 5 mg discharge prescriptions in public hospitals using electronic prescribing in Queensland, Australia by evaluating the proportion of oxycodone 5 mg discharge prescriptions written for ≤ 10 tablets across the study period. Method This research utilised a retrospective uncontrolled interrupted time-series design and was undertaken at 12 public hospitals using electronic prescribing from December 2018 to February 2021. The study analysed the impact of two sequential policy interventions that limited the recommended quantity of oxycodone 5 mg on discharge for all hospitalised patients. The first state-wide policy came into effect on 19 September 2019 and the second national policy came into effect on 1 June 2020. Results Over the 27-month period, there were 110,728 discharge prescriptions written in the 12 Queensland hospitals for oxycodone 5 mg. During the baseline period, approximately 50.7% (95% CI 49.5–51.8) of all oxycodone 5 mg prescriptions were from tablet quantities of ≤ 10 tablets. After the implementation of the state-wide policy, the proportion increased by 9% (95% CI 7.4–10.7; p = 0.001). The implementation of the national policy increased the proportion of oxycodone 5 mg prescriptions written for ≤10 tablets by 9.8% (95% CI 8.1–11.5; p < 0.001). Conclusions Restrictive prescribing policies at a state and national level may have resulted in decreased quantities of oxycodone 5 mg prescriptions provided on discharge from public hospitals using electronic prescribing in Queensland, Australia. Despite these positive results, continued multi-faceted policy efforts and individual tailored interventions are necessary to ensure safe and judicious opioid prescribing.

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Section: Introductionmentioning

confidence: 99%

“…A recent study in Australia, using group-based trajectory modelling to define persistent use, found that 2.6% of adults initiating opioids became persistent users over a 12-month period [ 16 ]. Further research suggests concerns regarding the appropriateness and number of opioid prescriptions written on discharge [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of Policy Interventions on Oxycodone Prescribing in Queensland, Australia: An Uncontrolled Interrupted Time Series Study

2022

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“…The opioid epidemic represents the advent of signi cant public health challenges, setting the stage for substantial public health cost (Seaton et al, 2007;Pouryahya et al, 2020). The most readily prescribed and abused opioids include buprenorphine, morphine, and oxycodone (OXY), each often prescribed to women as an analgesic for postpartum treatment (Hodder et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…The most readily prescribed and abused opioids include buprenorphine, morphine, and oxycodone (OXY), each often prescribed to women as an analgesic for postpartum treatment (Hodder et al, 2021). OXY is teratogenic and readily crosses the placental barrier leading to impairments in fetal development (Pouryahya et al, 2020). Several of our previously published studies have provided evidence of phenotypic, behavioral, biochemical, and synaptic vulnerabilities of postnatal OXY-exposed offspring (PNO) and in utero OXYexposed offspring (IUO) in early life and adulthood (Doberczak et al, 1991;Jones et al, 2010;Shahjin et al, 2019;Odegaard et al, 2020a;Odegaard et al, 2020b;Odegaard et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

An Integrated Systems Approach to Decode the Impact of Adolescent Nicotine Exposure in Utero and Postnatally Oxycodone Exposed Offspring

Flores

Gowen

Schaal

et al. 2023

Preprint

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Perinatal exposure to prescription opioids pose a critical public health risk. Notably, research has found significant neurodevelopmental and behavioral deficits between in utero (IUO) and postnatal (PNO) oxycodone-exposed offspring but there is a notable gap in knowledge regarding the interaction of these groups to other drug exposure, particularly nicotine exposure. Nicotine's widespread use represents a ubiquitous clinical interaction that current research does not address. Children often experiment with drugs and risky behavior; therefore, adolescence is a key timepoint to characterize. This study employed an integrated systems approach to investigate escalating nicotine exposure in adolescence and subsequent nicotine withdrawal in the IUO- and PNO-offspring. Western blot analysis found alterations of the blood-brain barrier (B.B.B.) and synaptic proteins. RT-qPCR further validated immune dysfunction in the central nervous system (CNS) consistent with compromised B.B.B. Peripheral nicotine metabolism was consistent with increased catabolism of nicotine concerning PNO & IUO, a predictor of greater addiction risk. Lastly, behavioral assays found subtle deficits to withdrawal in nociception and anxiety-like behavior. This study showed, for the first time, the vulnerabilities of PNO- and IUO-exposed groups concerning nicotine use during early adolescence and withdrawal.

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“…1,2 Opioids accounted for 23.2% of ED discharge prescriptions 3 and were provided on discharge for 6.4% of patient presentations. 4 Opioid prescribing requires careful planning due to potentially serious adverse outcomes, including dependence and overdose. [5][6][7][8] To reduce this risk, opioids should be used at the lowest effective dose for the shortest appropriate duration.…”

Section: Introductionmentioning

confidence: 99%

Design and implementation of an electronic opioid management plan to support consistent communication of opioid analgesia prescribing intentions to patients and general practitioners

Aminian

McMaster

et al. 2023

Pharmacy Practice and Res

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Opioid prescribing requires careful planning to minimise the risk of serious adverse outcomes. However, documentation of discharge opioid plans for patients and their general practitioners (GPs) is inconsistent, particularly when opioids are commenced in the emergency department or after surgery. We describe an initiative to promote consistent discharge opioid plan communication by implementing an opioid management plan (OMP) in our hospital's electronic medical record. Completion of an electronic form by the prescriber generates an OMP note in the medical history, which is used by the pharmacist to provide tailored opioid patient education. The OMP also populates the discharge summary that is sent to the GP and the Australian national digital health record platform, My Health Record. Preliminary evaluation shows incorporating OMP documentation into routine workflows has assisted prescribers to consistently document the plan for supplied opioids, supporting continuity of care. Workflow optimisation is ongoing to further improve discharge summary documentation and provision of patient‐friendly written information. This study was conducted as a quality improvement project and audits conducted as part of the project were approved by Austin Health's Office for Research (Project No: LNR/18/Austin/155). Informed patient consent was not required by Austin Health.

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Oxycodone prescribing in the emergency department during the opioid crisis

Cited by 8 publications

References 11 publications

Impact of Policy Interventions on Oxycodone Prescribing in Queensland, Australia: An Uncontrolled Interrupted Time Series Study

Impact of Policy Interventions on Oxycodone Prescribing in Queensland, Australia: An Uncontrolled Interrupted Time Series Study

An Integrated Systems Approach to Decode the Impact of Adolescent Nicotine Exposure in Utero and Postnatally Oxycodone Exposed Offspring

Design and implementation of an electronic opioid management plan to support consistent communication of opioid analgesia prescribing intentions to patients and general practitioners

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