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      Impact of a State Opioid Prescribing Limit and Electronic Medical Record Alert on Opioid Prescriptions: a Difference-in-Differences Analysis

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          Abstract

          Prescribing limits are one policy strategy to reduce short-term opioid prescribing, but there is limited evidence of their impact. Evaluate implementation of a state prescribing limit law and health system electronic medical record (EMR) alert on characteristics of new opioid prescriptions, refill rates, and clinical encounters. Difference-in-differences study comparing new opioid prescriptions from ambulatory practices in New Jersey (NJ) to controls in Pennsylvania (PA) from 1 year prior to the implementation of a NJ state prescribing limit (May 2016–May 2017) to 10 months after (May 2017–March 2018). Adults with new opioid prescriptions in an academic health system with practices in PA and NJ. State 5-day opioid prescribing limit plus health system and health system EMR alert. Changes in morphine milligram equivalents (MME) and tablet quantity per prescription, refills, and encounters, adjusted for patient and prescriber characteristics. There were a total of 678 new prescriptions in NJ and 4638 in PA. Prior to the intervention, median MME/prescription was 225 mg in NJ and 150 mg in PA, and median quantity was 30 tablets in both. After implementation, median MME/prescription was 150 mg in both states, and median quantity was 20 in NJ and 30 in PA. In the adjusted model, there was a greater decrease in mean MME and tablet quantity in NJ relative to PA after implementation of the policy plus alert (− 82.99 MME/prescription, 95% CI − 148.15 to − 17.84 and − 10.41 tabs/prescription, 95% CI − 19.70 to − 1.13). There were no significant differences in rates of refills or encounters at 30 days based on exposure to the interventions. Implementation of a prescribing limit and EMR alert was associated with an approximately 22% greater decrease in opioid dose per new prescription in NJ compared with controls in PA. The combination of prescribing limits and alerts may be an effective strategy to influence prescriber behavior. The online version of this article (10.1007/s11606-019-05302-1) contains supplementary material, which is available to authorized users.

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          Most cited references20

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          Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults: 2015 National Survey on Drug Use and Health

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            Prescription Opioid Analgesics Commonly Unused After Surgery

            Prescription opioid analgesics play an important role in the treatment of postoperative pain; however, unused opioids may be diverted for nonmedical use and contribute to opioid-related injuries and deaths.
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              Opioid Prescribing in the United States Before and After the Centers for Disease Control and Prevention's 2016 Opioid Guideline

              Background: In response to adverse outcomes from prescription opioids, the Centers for Disease Control and Prevention (CDC) released the Guideline for Prescribing Opioids for Chronic Pain in March 2016. Objective: To test the hypothesis that the CDC guideline release corresponded to declines in specific opioid prescribing practices. Design: Interrupted time series analysis of monthly prescribing measures from the IQVIA transactional data warehouse and Real-World Data Longitudinal Prescriptions population-level estimates based on retail pharmacy data. Population size was determined by U.S. Census monthly estimates. Setting: United States, 2012 to 2017. Patients: Persons prescribed opioid analgesics. Measurements: Outcomes included opioid dosage, days supplied, overlapping benzodiazepine prescriptions, and the overall rate of prescribing. Results: The rate of high-dosage prescriptions (≥90 morphine equivalent milligrams per day) was 683 per 100 000 persons in January 2012 and declined by 3.56 (95% CI, −3.79 to −3.32) per month before March 2016 and by 8.00 (CI, −8.69 to −7.31) afterward. Likewise, the percentage of patients with overlapping opioid and benzodiazepine prescriptions was 21.04% in January 2012 and declined by 0.02% (CI, −0.04% to −0.01%) per month before the CDC guideline release and by 0.08% (CI, −0.08% to −0.07%) per month afterward. The overall opioid prescribing rate was 6577 per 100 000 persons in January 2012 and declined by 23.48 (CI, −26.18 to −20.78) each month before the guideline release and by 56.74 (CI, −65.96 to −47.53) per month afterward. Limitation: No control population; inability to determine the appropriateness of opioid prescribing. Conclusion: Several opioid prescribing practices were decreasing before the CDC guideline, but the time of its release was associated with a greater decline. Guidelines may be effective in changing prescribing practices. Primary Funding Source: CDC.
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                Author and article information

                Journal
                Journal of General Internal Medicine
                J GEN INTERN MED
                Springer Science and Business Media LLC
                0884-8734
                1525-1497
                October 10 2019
                Article
                10.1007/s11606-019-05302-1
                7080923
                31602561
                31535c66-cf5b-43cb-97ef-46a5e72c087b
                © 2019

                http://www.springer.com/tdm

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