Effects of Prescribing Trends on the Opioid Epidemic

Limited information has been published on institutional determinants of prescribing opioids and their possible relationship to the opioid epidemic.

SAN ANTONIO–Researchers from Brigham and Women’s Hospital (BWH) and BWH/Massachusetts General Health (MGH) Care Center (FXB) have found notable differences in opioid prescribing trends between the 2 institutions, establishing benchmarks that may help understand opioid prescribing decisions and areas of concern.1

These results were presented at the American Academy of Pain Management (AAPM) Annual Meeting, which took place September 22-25, 2016 in San Antonio, Texas.1

“Despite [the] alarming numbers [of escalating opioid dependency, addiction, and deaths in the US], limited information has been published on institutional determinants of prescribing for opioids and the relationship if any to the ‘opioid epidemic,’” wrote Alan F. Kaul, PharmD, MS, FCCP, DAAPM and colleagues.

To identify prescribing trends of oral opioid prescriptions at BWH and FXB and to establish a baseline for evaluating changes, the researchers conducted a retrospective drug utilization review of oral opioid prescriptions that were filled at the main ambulatory and satellite pharmacies between 2013 and 2015.

Brigham and Women’s Hospital (BWH):

  • is a 757-bed general medical and surgical facility
  • had 45 352 admissions in the most recently reported year
  • had 18 626 annual inpatient surgeries, 13 325 outpatient surgeries, and 62 098 emergency room visits

BWH/MGH Health Care Center (FXB) in Foxborough, Massachusetts:

  • is a satellite ambulatory center
  • provides elective day surgery, urgent care, primary care
  • provides more than 20 specialty services including pain management, diagnostic radiology, and laboratory services

The researchers normalized the opioids that were dispensed by using equi-analgesic doses reported in morphine equivalents, and evaluated the days’ supply/Rx and the total Morphine Equivalent Doses (MED)/Rx using trend analysis within each pharmacy.2 They then compared the trends between each.

Out of a total of 28 477 oral opioid prescriptions evaluated, 21 436 were filled at BWH and 7131 were filled at FXB. At BWH, the MEDs/Rx increased for hydrocodone, morphine, and oxycodone, but not for methadone or hydromorphone; the days’ supply/Rx did not change.

At FXB, the MEDs/Rx increased for hydromorphone and oxycodone, but not for hydrocodone, methadone, or morphine. The days’ supply/Rx increased for hydrocodone, hydromorphone, and oxycodone, but not methadone or morphine. An association was not found when comparing the trends between BWH and FXB.

“By establishing benchmarks identified in this study, [we] hope that this institution and other institutions that replicate the methodology can better understand prescribing determinants and identify areas of concern to improved oral opioid prescribing and decreased morbidity and mortality,” the authors concluded.

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1. Kaul AF, Ross EL, Silva C, Burton D, Huang C. Are Prescribing Trends Driving the “Opioid Epidemic”? Presented at: AAPM 2016. September 22-25, 2016; San Antonio, Texas. Abstract 22.

2. Von Korff M, et al. De facto long-term opioid therapy for noncancer pain. Clin J Pain. 2008;24(6):521-527.