Effect of a legislative mandate on opioid prescribing for back pain in the emergency department

Moteb Khobrani, Stephen Perona, Asad E Patanwala

Research output: Contribution to journalArticle

Abstract

Objective: A change in Arizona State law in 2017 required prescribers to review data from a prescription drug monitoring program (PDMP) prior to opioid prescribing. The objective was to determine the effect of this change on opioid prescribing for patients who presented to the emergency department (ED) for back pain. Methods: This was a retrospective cohort study conducted in a 50-bed community ED in the United States. Consecutive adult patients who presented to the ED with back pain were included. Patients were categorized based on when they presented to the ED in reference to the law mandating PDMP review: 1) pre-PDMP and 2) post-PDMP. The outcome measures included the proportion of patients who were prescribed opioids upon discharge and the total amount of opioids prescribed per patient in oral morphine milligram equivalents (MME). Results: A total of 268 patients were included (134 in pre-PDMP and 134 in post-PDMP). Opioid prescribing on discharge from the ED occurred in 46% (n = 62) of patients in the pre-PDMP group and 48% (n = 64) of patients in the post-PDMP group (difference 2%, 95% CI −11 to 13%). Of those who received opioid prescriptions, the median total prescribed MME was 75 mg (IQR 60–120 mg) in the pre-PDMP group and 75 mg (IQR 60–90) in the post-PDMP group (mean difference 8 mg, 95% CI -9 to 24 mg). Conclusion: A legislative requirement for provider PDMP review did not change opioid prescribing for patients in the ED who presented with back pain.

Original languageEnglish (US)
JournalAmerican Journal of Emergency Medicine
DOIs
StatePublished - Jan 1 2019

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Prescription Drugs
Drug Monitoring
Back Pain
Opioid Analgesics
Hospital Emergency Service
Morphine
Prescriptions
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)

Keywords

  • Analgesics opioid
  • Controlled substances
  • Emergency service hospital
  • Narcotics
  • Prescription drug monitoring programs

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Effect of a legislative mandate on opioid prescribing for back pain in the emergency department. / Khobrani, Moteb; Perona, Stephen; Patanwala, Asad E.

In: American Journal of Emergency Medicine, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Objective: A change in Arizona State law in 2017 required prescribers to review data from a prescription drug monitoring program (PDMP) prior to opioid prescribing. The objective was to determine the effect of this change on opioid prescribing for patients who presented to the emergency department (ED) for back pain. Methods: This was a retrospective cohort study conducted in a 50-bed community ED in the United States. Consecutive adult patients who presented to the ED with back pain were included. Patients were categorized based on when they presented to the ED in reference to the law mandating PDMP review: 1) pre-PDMP and 2) post-PDMP. The outcome measures included the proportion of patients who were prescribed opioids upon discharge and the total amount of opioids prescribed per patient in oral morphine milligram equivalents (MME). Results: A total of 268 patients were included (134 in pre-PDMP and 134 in post-PDMP). Opioid prescribing on discharge from the ED occurred in 46{\%} (n = 62) of patients in the pre-PDMP group and 48{\%} (n = 64) of patients in the post-PDMP group (difference 2{\%}, 95{\%} CI −11 to 13{\%}). Of those who received opioid prescriptions, the median total prescribed MME was 75 mg (IQR 60–120 mg) in the pre-PDMP group and 75 mg (IQR 60–90) in the post-PDMP group (mean difference 8 mg, 95{\%} CI -9 to 24 mg). Conclusion: A legislative requirement for provider PDMP review did not change opioid prescribing for patients in the ED who presented with back pain.",
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