Restrictions on intravenous opioid products at an academic medical institution during a critical drug shortage were not found to have significant impact on overall institutional opioid utilization, according to study results published in Pain Medicine.

In times of critical opioid shortages, as was the case in late 2017, many institutions implement restrictions on opioid use, including a more conservative use of injectable opioids.

The objective of this single-center retrospective study was to examine the impact at a medical institution of restrictions on intravenous opioid products between July 2017 and June 2018 on inpatient utilization of those medications (ie, use of oral and injectable opioids; total institutional opioid administration; and utilization of individual restricted opioid agents). During this time period, national critical shortages of injectable fentanyl, hydromophone, and morphine occurred.

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Utilization was quantified in milligrams of intravenous morphine equivalent administered or dispensed per admitted patient. Medication ordering restrictions enacted during the study period were grouped into 10 discrete phases defined based on significant changes in the availability of injectable opioids.

Although sequential restriction was accompanied by changes in use of individual agents, there was no significant impact on total opioid use.

“Soft” restrictions, defined as an automatic warning message providing information on product availability and alternatives, were not found to have a direct significant impact on medication use, although utilization was reduced over time. “Hard stop” restrictions, defined as an automatic warning message that communicated essential information using the electronic health record and blocking the order, were found to directly reduce opioid usage.

Study limitations include significant variability in day-to-day utilization, the fact that fluctuations in the number or types of surgeries or injuries during the study period were not adjusted for, that not all opioids were restricted, and that the results may not be applicable to other types of institutions.

“Our findings suggest that a series of medication restrictions did not have a significant impact on overall institutional opioid utilization,” noted the study authors.


Brokenshire SA, Lemon SJ, Staley B, Voils A, Hincapie-Castillo JM. Impact of opioid restrictions during a critical drug shortage period: Interrupted time series for institutional opioid utilization (published online, Sep 2, 2020). Pain Med. doi: 10.1093/pm/pnaa211