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Impact of an Opioid Prescribing Guideline in the Acute Care Setting

The Journal of Emergency Medicine, In Press, Corrected Proof, Available online 15 August 2015, January 1970

Abstract

Background

Death from opioid abuse is a major public health issue. The death rate associated with opioid overdose nearly quadrupled from 1999 to 2008. Acute care settings are a major source of opioid prescriptions, often for minor conditions and chronic noncancer pain.

Objective

Our aim was to determine whether a voluntary opioid prescribing guideline reduces the proportion of patients prescribed opioids for minor and chronic conditions.

Methods

A retrospective chart review was performed on records of adult emergency department visits from January 2012 to July 2014 for dental, neck, back, or unspecified chronic pain, and the proportion of patients receiving opioid prescriptions at discharge was compared before and after the guideline. Attending emergency physicians were surveyed on their perceptions regarding the impact of the guideline on prescribing patterns, patient satisfaction, and physician−patient interactions.

Results

In our sample of 13,187 patient visits, there was a significant (p < 0.001) and sustained decrease in rates of opioid prescriptions for dental, neck, back, or unspecified chronic pain. The rate of opioid prescribing decreased from 52.7% before the guideline to 29.8% immediately after its introduction, and to 33.8% at an interval of 12 to 18 months later. The decrease in opioid prescriptions was observed in all of these diagnosis groups and in all age groups. All 31 eligible prescribing physicians completed a survey. The opioid prescribing guideline was supported by 100% of survey respondents.

Conclusions

An opioid prescribing guideline significantly decreased the rates at which opioids were prescribed for minor and chronic complaints in an acute care setting.

Keywords: narcotic, opioid abuse, emergency department, overdose, prescribing guideline.

Footnotes

Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania

Reprint Address: Daniel A. del Portal, MD, Department of Emergency Medicine, Temple University School of Medicine, 1316 West Ontario Street, 10th Floor, Philadelphia, PA 19140