Opioid prescribing guidelines were linked to small changes in morphine equivalent units (MEU) ordered in the ED, according to the authors of a study.1

A suburban academic ED implemented the guidelines in September 2016. Researchers conducted a “before and after” study to determine if those would change the use of IV opioids per patient and the MEU per patient.

A total of 108,327 IV opioid orders were analyzed. After the guidelines were adopted, the expected number of IV opioids dropped by 3.1%, with an additional decrease of 0.1% per month. The average MEU dropped by 0.3 mg, with a decrease of 0.01 mg per month. “While there have been many contributing factors to the opioid epidemic, our emergency department desired to be part of the solution,” says David A. Berger, MD, one of the study’s authors and assistant professor in the department of emergency medicine at Oakland University William Beaumont School of Medicine in Rochester, MI.

The authors of previous studies focused mainly on oral opioid prescriptions, with less attention on IV ordering in the ED. “Our sincere hope is that by better characterizing the impact of an opioid prescribing guideline on IV ordering, we could jumpstart this aspect of opioid epidemic research,” Berger offers.

The analysis by Berger and colleagues did not demonstrate a statistically significant reduction in IV opioid orders after the opioid prescribing guidelines were implemented. This finding could be because of the study’s timing. “There was already increased prescriber awareness prior to implementing our guideline,” Berger explains.

Another factor is patients exhibiting opioid-addicted behaviors may be less likely to return to the ED once they are aware of the post-guideline change in ordering behavior.

To avoid dissuading any patient from seeking care, the opioid prescribing guideline was not posted in the ED triage area. “Patients who exhibit opioid-addicted behavior in an ED setting may be receptive to discussions regarding their opioid use disorder,” Berger notes.

The ED incorporated screening for opioid use disorder as part of the intake process. “We have utilized our ED-led program to provide medication-assisted treatment as a bridge to outpatient services,” Berger adds.


  1. Maloy JD, Chen NW, Qu L, et al. Opioid ordering habits in the acute emergency department visit: Before and after implementation of departmental prescribing guidelines. J Am Coll Emerg Physicians Open 2020;1:1472-1479.