Effect of Prescription Drug Monitoring Program Implementation on ED Opioid Prescriptions

Emergency department sign
Emergency department sign
Prescription drug monitoring programs may reduce the overall opioid prescribing rate in emergency departments.

LAS VEGAS – Prescription drug monitoring programs (PDMPs) may reduce the overall opioid prescribing rate in emergency departments (EDs), according to study results presented at PAINWeek 2019 held September 3-7 in Las Vegas, Nevada.

The study included participants discharged from the ED who received opioid prescriptions that were added to electronic medical records before and after the statewide implementation of a PDMP system. The monthly rates of opioid prescriptions pre-PDMP implementation (from December 2014 to August 2016) and post-PDMP implementation (from September 2016 to May 2018) were compared. PDMP was implemented on August 25, 2016. The ratio of the number of participants given ≥1 opioid prescription to the number of ED patients with a numeric pain score (NPS) >0 was used as the monthly opioid prescription rate. Pain scores were categorized as mild (NPS scores, 1-4), moderate (NPS scores, 5-6), and severe (NPS scores, 7-10).

In the pre-PDMP period, data on 12,058 participants (7399 men and 4659 women) were collected. Of these, 3049 patients reported mild pain, 2621 reported moderate pain, and 6388 reported severe pain. A total of 51.3% of participants received opioid prescriptions during the pre-PDMP period.

In the post-PDMP period, data on 14,745 participants (8986 men and 5759 women) were collected. Of these, 4732 patients reported mild pain, 3301 reported moderate pain, and 6712 reported severe pain. During this time period, 47.9% of participants received opioid prescriptions.

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Prescribing rates decreased from 51.3% to 47.9%, from pre- to the post-PDMP implementation, respectively. Among men, the prescription rate decreased from 51.1% pre-PDMP to 46.7% post-PDMP (P <.0001). The prescription rate in women was comparable pre-and post-PDMP implementation (51.6% and 49.7%, respectively; P =.0529).

For participants with mild pain, the prescription rate increased from pre-PDMP to post-PDMP implementation (27.5% vs. 34.3%, respectively; P <.0001). The prescription rate in patients with moderate pain did not change significantly (pre-PDMP, 42.8%; post-PDMP, 43.5%; P =.5924), but decreased in patients with severe pain (pre-PDMP, 66.1%; post-PDMP, 59.6%; P <.0001).

“Ultimately, these data evoke an interesting discussion and questions for further research, such as investigation of opioid prescription rates after direct point-of-care PDMP integration into the [electronic medical records],” noted the study authors.

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Gupta R, Boehmer S, Giampetro D, DeFlitch C. The effect of the prescription drug monitoring program on emergency department opioid prescribing habits. Presented at: PAINWeek 2019; September 3-7, 2019; Las Vegas, NV. Poster 99.